MSF And North Korea 1995-1998

Editorial Committee: Laurence Binet, Françoise Bouchet-Saulnier, Marine Buissonnière, Katharine Derderian, Rebecca Golden, Michiel Hofman, Kris Torgeson - Director of Studies (project coordination - research - interview - editing): Laurence Binet - Assistant: Bérengère Cescau - Transcription of interviews: Laurence Binet, Françoise Courteville, Pascale Donati, Jonathan Hull, Mary Sexton - Translation into English: Amanda Harvey, Imogen Forster, Caroline Lopez-Serraf, Nicolas Rainaud - Proof reading: Rebecca Golden - Jacqui Tong - Design and layout: TC Graphite - Video research: Céline Zigo - Video editing: Sara Mac Leod - Website designer: Sean Brokenshire.

Thanks to MSF Australia team for their support.

Thanks to Rony Brauman for his advice.

Produced by the Médecins Sans Frontières International Movement.

MSF Australia is in charge of the design, running, update, and promotion strategy of the website http://speakingout.msf.org

FOREWORD

This publication is part of the “Médecins Sans Frontières Speaking Out” case studies series prepared in response to the MSF International Council’s wish to provide the movement with literature on MSF témoignage (advocacy).

The idea was to create a reference document that would be straightforward and accessible to all and help volunteers understand and adopt the organization’s culture of speaking out.

It was not to be an ideological manual or a set of guidelines. Témoignage cannot be reduced to a mechanical application of rules and procedures as it involves an understanding of the dilemmas inherent in every instance of humanitarian action.

The International Council assigned the project to a director of studies, who in turn works with an editorial committee composed of MSF representatives chosen by the International Board for their experience and expertise. They serve in their capacity as individuals and do not represent their national sections.

Faced with the difficulty of defining the term témoignage, the editorial committee decided to focus the series on case studies in which speaking out posed a dilemma for MSF and thus meant taking a risk.

Key information sources -MSF volunteers’ written and oral recollections — are reconstructed by highlighting documents from the period concerned and interviewing the main actors.

The individuals interviewed are chosen from lists prepared by the operational sections involved in each case. Speaking in the language they choose, these individuals offer both their account of events and their assessment of MSF’s response. The interviews are recorded and transcribed.

Document searches are conducted in the operational sections’ archives and, as far as possible, press archives.

The research is constrained by practical and financial issues, including locating interviewees and securing their agreement and determining the existence, quality and quantity of archived materials.

The methodology aims at establishing the facts and setting out a chronological presentation of the positions adopted at the time. It enables the reconstruction of debates and dilemmas without pre-judging the quality of the decisions made.

The main text describes events in chronological order. It includes excerpts from documents and interviews, linked by brief introductions and transitional passages. We rely on document extracts to establish the facts as MSF described and perceived them at the time. When documentation is missing, interviews sometimes fill the gaps. These accounts also provide a human perspective on the events and insight into the key players’ analyses.

Preceding the main texts collected, the reader will find a map, a list of abbreviations and an introduction that lays out the context of MSF’s public statements and the key dilemmas they sought to address.

In addition, a detailed chronology reconstructs MSF’s actions and public statements in regional and international news reports of the period.

Each case study was written in French and translated into English and is available in both languages.1

These case studies were essentially designed as an educational tool for associative members of the organisation. With the hope of broadening their educational scope the studies are now being made available to the public for free, on the website www.speakingout.msf.org, the various English and French-language websites of individual sections of Médecins Sans Frontières, and on Google Book.

We hope you find them useful.

The Editorial Committee.

April 2013

1. Document excerpts and interviews have been translated into both languages.

PEOPLE INTERVIEWED AND THEIR POSITION AT THE TIME OF THE EVENTS

Dr. Philippe Biberson President MSF France - interviewed in 2000

Marine Buissonnière Administrator, MSF France in China, December 1996 to January 1999; Director of programs, MSF Japan, April 2000 to September 2001; Coordinator MSF France in South Korea, February 2002 to November 2003; General Secretary, MSF International 2004-2007; Exploratory mission MSF Switzerland, April 2007 - interviewed in 2007

Samantha Bolton Communications coordinator, MSF International - interviewed in 2000

William Claus MSF Belgium Programme Manager - interviewed in 2000

Sophie Delaunay Research officer, Foundation MSF France, June to August 1998; Coordinator, MSF France in China, January 1999 to December 2001; co-coordinator, MSF France in South Korea, January 2002 to October 2003 - interviewed in 2007

Antoine Gérard Head of Programmes Department, MSF USA - interviewed in 2000

Dr. Eric Goemaere Executive Director MSF Belgium - interviewed in 2000

Pim De Graaf MSF Holland Executive Director - interviewed in 2000

Dr. M Physician, MSF Programme in DPRK, September to December 1995, January 1997 - interviewed in 2000, June 1997 - interviewed in 2001

Anne-Marie HubyExecutive Director, MSF UK - interviewed in 2000

Dr. Dominique Lafontaine Physician, MSF Programme in DPRK, August 1997 to September 1998 - interviewed in 2007

Olivier Lesrel Manager of MSF’s Emergency Food Cell

Marie-Rose Pecchio Coordinator, MSF Programme in DPRK, November 1997 to September 1998 - interviewed in 2001

Jules PietersMSF Holland Emergency Programme Manager

Pierre Salignon MSF France Programme Manager, from October 1997 on, then MSF France Executive Director from January 2004 on - interviewed in 2000

Dr. Corien Swann Physician, MSF Programme in DPRK, January to September 1998 - interviewed in 2007

Dick van der Tak Coordinator MSF Holland in China, January 1999 to May 2000; MSF Holland HAD adviser, July 2000 to June 2003; MSF Hong Kong Executive Director from 2003 on - interviewed in 2007

ABBREVIATIONS

ACF Action contre la faim (Action Against Hunger)

AEDES Agence européenne pour le développement et la santé (European Agency for Development and Health)

AP Associated Press

BBC British Broadcasting Corporation

BP5 Biscuits protéinés (High Proteïn Biscuits)

CAD Comité d’aide au développement (Development Aid Committee)

CDC Center for Disease Control and Prevention

CBS Columbia Broadcasting System

CESVI Cooperazione e sviluppo (Italian Cooperation and Developement Organisation)

CIA Central Intelligence Agency

CNN Cable News Network

DG 8 European Union Direcorate General in Charge of Humanitarian Action

ECHO European Community Humanitarian Office

EuronAid European Ngos network

FAO Food and Agriculture Organisation (United Nations)

FDRC Flood Damages Rehabilitation Committee

GAA Global Action on Aging

HCR-UNHCR United Nations High Commissioner for Refugees

ICN Institute for Children Nutrition

IDA International Dispensary Association

IFRC International Federation of Red Cross + Red Crescent Societies

ICRC International Committee of the Red Cross

KEDO Korean Energy Development Organisation

MDM Médecins du Monde (Doctors of The World)

MOU Memorandum of Understanding

MUAC Mid-Upper Arm Circumference (method of assessment of malnutrition)

NBC National Broadcasting Company

NRC Nutritional Rehabilitation Center

OCHA Office for the Coordination of the Humanitarian Affairs (United Nations)

ORS Oral Rehydratation Salt

Oxfam Oxford Commitee for Famine Relief

PDS Public Distribution System (North Korea)

DPRK Democratic People’s Republic of Korea

WHO World Health Organisation (United Nations)

SCF Save the Children Fund

TFC Therapeutic Nutrition Center

UDA Unité de distribution alimentaire (Food Aid Distribution Cell)

Unicef United Nations Children’s Funds

UNDP United Nations Development Programme

Unesco United Nations Science, Education and Culture Organisation

USAID United States Agency for International Development

WTN Worldwide Television News (international video press agency merged with Associated Press TV (APTV, UK) in 1998)

INTRODUCTION

In August 1995, for the first time in its history, North Korea launched a call for international aid following the destruction of its harvests by flooding.

Following the breakdown of the Soviet Union, its main source of support, the planned economy of this closed off country gradually collapsed. The population, completely dependent on the regime’s arbitrary resource management, experienced shortages of energy, food and medicines.

The countries involved in the Korean crisis ( regional powers and the USA) were anxious to avoid a sudden collapse of North Korea, which would impact on the entire region. They were encouraging peace negotiations between the two Koreas and a freezing and dismantling process of North Korea’s nuclear arms. The United-Nations responded to this appeal with the delivery of millions of tons of aid, thereby entering into years of an on-going bargaining process linking the progress of negotiations to the allocation of aid.

From October to December 1995, an international MSF team, composed of volunteers from the Belgian, French and Dutch sections, set up a programme in North Korea providing epidemiological monitoring of diarrhoea and distributing medicines and medical material.

In January 1997, MSF again received authorisation to open up a barley seed distribution programme, and then, from June 1997 on, over several provinces, a one year programme providing support to improve nutritional therapeutic care to malnourished children, the distribution of medical material and medicines and training, and drinking water to health centres.

For one and a half years, 13 MSF expatriates from three different sections followed the example of their colleagues who had passed through the country in 1995, working under tight surveillance and being unable to evaluate needs on the basis of objective criteria or check the final destination of their aid. Nonetheless, some of them were encouraged by certain signs or events. There was the organisation of case management for a group of children totally excluded by the system, for example.

Meanwhile, the MSF France team in China, receiving information on the outcome of North Korean refugees in China, carried out two visits (in April and August 1998) to the Sino-North Korean border. The refugees provided them with descriptions of a large-scale famine, violence and the reign of the arbitrary in the country. They also reported that international aid was distributed as a priority to the army and individuals identified as “socially useful” and faithful to the regime.

This situation was also reported by South Korean organisations providing assistance to refugees and the international press, which started containing echoes of famine in North Korea.

In August 1998, after several months of negotiation on the renewal of the Memorandum of Understanding, the North Korean authorities made only one proposition to MSF, being the organisation of an importation programme for basic materials, allowing the regime to rehabilitate the country’s pharmaceutics industry. MSF refused, considering that this type of activity did not fall within the mandate of a medical humanitarian organisation, and withdrew from North Korea.

Throughout this period, the occasions when MSF spoke out in public, whilst conducted in the name of the entire movement, caused disagreement between sections and/or between headquarters and the field teams. As it turns out, there are contradictions in their contents.

In December 1997, during a press conference, MSF insisted publically on the necessity of providing emergency assistance to the North Korean health system.

In April 1998, in the international press, MSF described the restrictions imposed on its teams during their activities carried out for the North Korean population and their doubts on the final destination of their aid, but stated that it did not have any solid proof for denying or confirming the existence of a famine. At the same time, the international press circulated witness accounts of North Korean refugees, received from the MSF team in China, reporting a famine situation.

On the 1st October 1998, during a press conference, MSF gave a public explanation of the reasons for its withdrawal from North Korea, shared its concern on the outcome of socially disadvantaged children excluded by the system and referred to the witness accounts of the North Korean refugees.

It also called on the international community to stop delivering aid to North Korea whilst it was unable to check that the aid was really reaching the most vulnerable members of the population.

Throughout this whole period, MSF was confronted with the following dilemmas and questions:

- Until which limit, could we, in order to draw closer to a population in distress, accept to work without being able to apply the basic principles of humanitarian action: access to populations, free evaluation of needs and supervision of the destination of our assistance?

- Should we accept to work for a population oppressed by a totalitarian regime with the risk of our assistance serving to reinforce this oppression, support this regime?

- Whilst making public calls for emergency aid for the North Korean health system, was MSF not participating in reinforcing the regime?

Epilogue :

In the years that followed, the French section, with the support of its internal centre for reflections, continued to document the deviations of international aid delivered to North Korea and spoke out on this subject in the press on several different occasions.

At the same time, it ran a programme of little operational stature (because partly clandestine) in an attempt to bring assistance to North Korean refugees in China or in transit through different countries in Asia and South Korea. From 2001 to 2003, MSF France spoke out publically several times to denounce the repression and forced repatriation suffered by these refugees in China, despite the presence of the United Nations High Commissioner for Refugees. As time passed, all MSF’s activities concerning North Korean refugees dwindled to a standstill.

Meanwhile in 2004, a visit by a delegation of MSF Holland to North Korea with the aim of preparing an exploratory mission led to nothing.

In 2007, new alarms sounded on the food situation in North Korea, and a continuous influx of refugees arrived on the Sino-Korean border, inciting the Swiss section to launch an exploratory mission, then a process of re-opening a programme for North Korean refugees.

www.vidéo. ► click to access the reference material list. Then click on the refering number to access the video.

MSF AND NORTH KOREA 1995-1998

From 1905, Korea was occupied by Japan. In 1945, after World War II, in accordance with a United Nations agreement following Japan’s defeat, the Korean peninsula was split into two parts divided by the 38th parallel. This line was previously chosen to define the areas where Russia and the US troops would operate respectively, to drive the Japanese out of Korea. The northern part was to be administered by the Soviet Union and the southern half by the United States. However, by 1948 the Soviets and the Americans had not implemented trusteeship of Korea, so two separate governments were established. The 38th parallel crystallised into a border.

Most of the United States armed forces withdrew from South Korea,2 where a pro-USA military regime was installed. At the same time, a communist regime was established in the newly born Democratic People’s Republic of Korea. In June 1950, the North Korean People’s Army crossed the 38th parallel with the claim to reunify Korea under its communist system. The ensuing ‘Korean War’ lasted until 1953. The North Korean troops were supported by the Chinese People Volunteers’ Army and received some assistance from the Soviet Union. The south was backed by United Nations forces, primarily but not entirely composed of soldiers from the USA. This was the first conflict of the Cold War. A ceasefire was reached on 27 July 1953 in Panmunjon. However, no armistice agreement has been implemented since, thus North and South Korea remain technically at war, having never signed a peace treaty. The two territories are still separated by the Korean Demilitarized Zone (DMZ), which is along the 38th parallel.

In North Korea, the first and so far only president of Democratic People’s Republic of Korea (DPRK), the ‘Great Leader’ Kim Il Sung established a dictatorship based on the Juche ideology. Its central component is the idea of self-reliance, which aimed at making North Korea economically, militarily, and culturally strong enough to resist foreign invasion and capitalist intervention and which arguably, was never achieved.

During four decades the DPRK state-controlled economy grew significantly, mainly oweing to its particular partnership with the Soviet Union and former members of the eastern block. However, in the early 1990’s, after the collapse of the USSR, the end of Soviet assistance to North Korean crises including energy and hard currency shortages as well as mechanised farming aid ground to a halt. Yet throughout this time, military budgets were maintained.

According to key observers and researchers, it was in the early nineties that the first food shortages occurred in North Korea. However, at that time these problems were unknown to the international community.

On 7 July, 1994, Kim Il Sung died and was designated the ‘Eternal President’. His son, Kim Jong Il appeared to become the country’s new leader, as technically, he was the Head of State, though he was never appointed as such nor was he the head of government3. On 22 July 1994, the USA and the DPRK came to an agreement to resume peace talks. On 11 September 1994, talks were held in Pyongyang but came to a deadlock on 28 September, in Geneva. Then, in October 1994, the United States and the Democratic People’s Republic of Korea signed the Agreed Framework, under which the DPRK agreed to freeze and ultimately dismantle its nuclear programme.

The agreed framework sought to comprehensively resolve the issues arising from the DPRK nuclear programme that was suspected of being a step towards a nuclear weapon programme. The Korean Peninsula Energy Development Organization (KEDO) was founded by the USA, South Korea, and Japan to implement this framework, mainly by constructing a light water reactor nuclear power plant in North Korea to replace the existing reactor in North Korea.

From that time on, the sequence of ‘resuming talks/breaking talks’ would be frequently replicated; the official reason for breaking the talks were because US, South Korean, or North Korean ‘spies’ were caught on a boat, submarine, or helicopter somewhere in or around the Korean peninsula. The defection of North Korean officials or incidents in the DMZ zone were cited as cause for breakdowns in negotiations. Each time, the main stakes to the bargain would be the resumption of the peace talks and the control of the North Korea nuclear capacity in exchange for increased ‘food aid’ deliveries.

In July and August 1995, floods affected several regions of North Korea. For the first time in its history, the DPRK Government, through the Flood Damage Rehabilitation Committee (FDRC), which was a government umbrella organization created in an ad hoc manner at the time to manage interactions with foreigners operating in the country, launched an appeal for international aid.

DOCUMENT

”Call for Emergency Humanitarian Assistance” Letter from the General Delegation of the Democratic People’s Republic of Korea in the French Republic to MSF France, Paris, 28 August, 1995 (in French).

Extract:

The General Delegation of the DPR of Korea in the French Republic presents its compliments to your organisation and takes this opportunity to call on its emergency humanitarian assistance for the victims of floods caused by the unprecedented torrential rain that inundated several regions in our country between 31st July and 18th August 1995.

As you know, the early hailstorms of October 1994 had already damaged our country. The havoc continued this year, this time caused by unprecedented flooding which hit more than 145 areas in 12 provinces and towns coming under the central authority. The average daily rainfall stood at between 110 to 362 mm, the flooding has affected 5.2 million inhabitants and destroyed a large number of homes, factories, agricultural structures and installations, livestock farming and facilities used for teaching, scientific, public health, transport, [and] communication [infrastructures], and factories, thereby causing considerable material damage. According to initial estimates, there is about 15 billion US$ worth of damage. The priority needs are supplies of food, medicines and diverse articles of common usage, as well as other material required for stabilising the lives of the homeless who need to rebuild their ravaged homes, schools, hospitals, railways, and communications installations as quickly as possible.

Familiar as I am with the humanitarian work carried out by your organisation through its rapid interventions in similar situations of suffering, the General Delegation of the DPR of Korea hopes it can count on your humanitarian goodwill and we thank your organisation in advance, in the name of the homeless, for being kind enough to join the efforts to relieve the victims’ suffering following this natural disaster.

DOCUMENT

”North Korea Makes Rare Plea After Floods Devastate Country” Kevin Sullivan, The Washington Post (Etats-Unis), 22 September 1995 (in English).

Extract:

Kim Myong Chol, an unofficial spokesman for North Korea who lives in Tokyo, said the decision to “send an SOS” was made by Kim Jong II. “Kim II Sung was the first generation of revolutionary fighters, so he would not ask for help,” Kim Myong Chol said. Kim Jong II is university-educated. He knows much more about the world. Kim Jong II is proud, but it is not below our dignity to ask for help in the case of a natural disaster. [...] North Korea has few friends, but among them is Bernard Krisher, a former Newsweek correspondent in Tokyo. Krisher, who is now involved in Asian relief projects, recently sent the North Korean government a letter asking officials if they would like him to post an Internet appeal for donations.

The North Korea’s Flood Damage Rehabilitation Committee responded by fax on Sept. 17, telling Krisher that it would welcome the Internet campaign. The fax said food and clothing would be welcome, but outside medical personnel would not, because North Korea had plenty of “talented doctors and nurses.” “North Korea may not be familiar with the Internet, but it does understand the acute crisis it faces ...,” says the notice Krisher plans to post this week on the Internet. “Politics should not play a role in assisting these helpless and homeless people in need. It is nature, not a political system, that has caused the flooding.”

An UN team visited North Korea this month. Based on estimates provided by the North Korean government, the United Nations reported that the floods caused $15 billion worth of damage affecting 5.2 million people; 96,348 homes had been damaged, displacing 500,000 people; and 1.9 million tons of crops had been lost. G. Faruq Achikzad, head of the UN Development Program office in Pyongyang, the North Korean capital, said in a telephone interview Wednesday that he had just toured much of the affected land by helicopter. He said that while the damage is severe, most of the homeless are living with neighbors, in schools, or in other public buildings. He said he saw no one without shelter. “You don’t see misery or anything like that,” Achikzad said. “The government has a very good system for dealing with this. It is very regulated and very disciplined.”

In addition to the $1.2 million in cash donations, the United Nations and other international organizations have pledged $700,000 in cash and more than $1 million worth of equipment, supplies and personnel. While that is significant, the world’s complicated relationship with communist North Korea has certainly blunted the relief response. The United States, Japan, and South Korea are still trying to reach an agreement with North Korea on a deal to provide it with nuclear power reactors in exchange for a promise to halt its suspected nuclear weapons program. The deal, supported by President Clinton, has many critics in the Republican-controlled Congress. The United States, which has no formal diplomatic relations with North Korea, is scheduled to open a liaison office in Pyongyang as early as this month. But this week the House of Representatives asked Clinton not to elevate diplomatic ties with North Korea until Pyongyang stops its nuclear program, resumes talks with South Korea, reduces its massive military presence on its border with South Korea and halts missile exports.

Japan announced this week that it will send $500,000 in aid to North Korea, but not without some scolding. Earlier this year, Japan abruptly halted its emergency rice donations when a North Korean government official said Japan was sending the rice to “atone” for its past aggression. In its statement announcing the flood-relief aid, Japan’s Foreign Ministry said Japan is satisfied that North Korea understands that the rice was offered for humanitarian reasons only. It said Japan is willing to discuss resuming rice donations.

Nowhere are the disaster relief politics more tortured than in South Korea, where a recent poll showed that 63 percent of South Koreans opposed giving flood aid. South Korea is providing 150,000 tons of emergency rice to North Korea. But in August, the North Koreans temporarily seized a ship delivering rice and accused the crew of spying. Another South Korean rice-delivery ship was briefly forced to fly the North Korean flag.

From 4-9 September, 1995, an MSF team of volunteers from MSF France, MSF Belgium and MSF Holland conducted an assessment mission in North Korea. The team was mainly being paraded around from one meeting to the other and was not able to carry out an independent evaluation. However, the team did not question the seriousness of the situation as described by the DPRK authorities.

DOCUMENT

Report on the “Exploratory Mission – Democratic People’s Republic of Korea – Médecins Sans Frontières – 4/9/95 to 10/9/95 – Dr Gerald Viretto, Mr Patrick Chomier ” 14 September 1995 (in English).

Extract:

In response to an appeal from the government of DPRK for international assistance following severe floods that occurred during the months of July and August 1995, an MSF team arrived in Pyongyang on the 4th of September. Its objectives were:

-To assess the impact of the disaster on the health system in the affected areas.

-To design and propose a project of emergency assistance.

DOCUMENT

“MoU DPRK/MSF: Terms of Negotiation” Annex to the Report of MSF’s Exploratory Mission in North Korea, 8 September 1995 (in French).

Extract:

Clauses 12, 13, 14 and 15 could be accepted if the permanent presence of expatriates in the field was accepted. This last point presented a stumbling block in the negotiations.

1. Arguments - for them our presence is:

-Pointless: there’s no need to have expats in the field, Korean doctors are sufficiently competent in using our medicines on their own.

-Superfluous: their own system for supervising the use of medicines performs sufficiently well.

-Inadequate: as the health system is totally free of charge in the DPRK, medicines (implying medicines that have perhaps been stolen) cannot be commercialised or negotiated (false because we can find medicines on sale in the big stores in Pyongyang).

-Technically difficult: several weeks are required for obtaining the different authorisations (capital, province, county, several ministries involved). In fact, it just requires the consent of the Dear Leader (a.k.a. Kim Jong II) for things to move very fast…

-Illegal: Korean law does not allow the presence of foreigners outside P.Y. This is false; members of the UN (UNICEF, WHO) have repeatedly spent several successive days in certain areas.

-Uncomfortable: living conditions in the countryside are inadequate for western visitors and do not meet the Korean people’s norms of hospitality (we’re used to living in difficult conditions and life in a luxury hotel would bother us rather than honour us).

-Unusual: other organisations (above all the UN) are satisfied with supervising from P.Y. or even better, holding inauguration ceremonies (best in P.Y. or, less interesting, in the field). These two options were proposed to us (we reminded them that until now they had claimed to be generally dissatisfied with the UN’s work…).

-Awkward: rural Koreans have bad memories of the Japanese colonisation and Nippon advisors. The presence of our expats could bring these bad memories to the surface, which would not be appreciated (in fact, in our opinion it is above all awkward for the government; the populations would soon work out the cause and effect connection between the sudden existence of sufficient quantities of effective medicines and the regular presence of our expats. This could expose the incredulous masses to the negligence of their government and, even worse, their system).

For us, this presence is indispensable because:

-It’s an integral part of the moral contract we have with our private donors, which involves guaranteeing the correct use of their money.

-It’s fundamentally ‘humanitarian’, with our teams working alongside the suffering population.

-It’s the way we normally work, in more than 50 countries, and we do not see any objective reasons (??) why this should be different in the People’s Democratic Republic of Korea (long silence, loaded with the unspoken).

-The contact and collaboration between Korean personnel and expats are sources of mutual enrichment (here, we’re really hypocritical).

2. Concessions:

-They’ve accepted the possibility of a team based in P.Y. paying periodic, regular visits to the different counties.

-We proposed the possibility of hotel accommodation, on the condition that it’s not too far away from the intervention areas and amounts to a temporary solution only.

We left it there, but they agreed to study this final proposition carefully [...].

General impression

They tried to deceive us […] They allowed us to think at the beginning of our stay that our preliminary conditions would pose no problems (particularly expat presence in the field), then during our final meeting they pretended that they had not understood (oh really, you want expats in the field!! Well, well, and what for!!) Maybe they aimed to let us get sufficiently drawn in (recruitment of staff for P.Y., preparation of kits, and full charters) so we couldn’t pull out at the last minute.

This expatriate presence is really the key point in the negotiations, and not all their arguments are demonstrations of bad faith. It really is a source of anxiety for them, and opens up perspectives of problems. […] Does this scare them more than the prospect of a winter of famine? [...] Whatever the case, it’s not surprising that this issue is already generating conflict between the elders and the more modern thinkers...

From our side, we should perhaps soften up our position, allowing them to get to know us, get used to us:

-2 expats per county instead of 3 (1 med, 1 log)

-Intermittent presence at the hotel with frequent returns to P.Y. (easy at UNPA, hard elsewhere).

If this type of solution is accepted, I think it’s important to insist on its temporary nature in the MoU (the time required for finding acceptable accommodation) so we don’t reach a point of no return. Don’t forget, the North Koreans have shown us that they know how to play the game. They were jubilant when they mentioned their atomic negotiations with the Americans (which lasted 20 full days) during which they obtained undreamed-of concessions….

INTERVIEW

Our first contact was when North Korea called for international aid, arguing three successive years of floods and droughts, so food difficulties, etc. We sent a first exploratory mission. Photos were circulated on its return. We could see that the team was passed around from official receptions to celebrations in stadiums. This first visit was extremely guided, respecting protocol, and consisted of obtaining guarantees, trying to find out if we could bring in foreign personnel, have access to health facilities, even move around outside the capital, live in the field, etc. The exploratory mission focused on hunger. They hadn’t tried to evaluate the situation from the population’s health perspective; its nutritional state.

Dr. Philippe Biberson, President MSF France (in French).

After difficult negotiations regarding the presence of MSF expatriates in the country, a Memorandum of Understanding was signed with the DPRK authorities. MSF launched a drug and medical equipment distribution programme in the provinces of North Pyongyang (Pakchon county), Chagang (Huichon county) and North Hwanghae (Unpa county). At the time, the members of the MSF France Board of Directors looked upon the DPRK appeal as a move toward an opening onto the world. On October 3, 1995, MSF Belgium, MSF France and MSF Holland issued a press release to announce the opening of this programme, matching their speech to the rhetoric of the government on the floods.

DOCUMENT

“Briefing of Expats Leaving,” Fax from Maurits Van Pelt, Coordinator of MSF Holland, Belgium, and Switzerland in Cambodia, member of the MSF exploratory mission in North Korea to Wilna van Aartzen, Programme manager MSF Holland, 28 September, 1995 (in English).

Extract:

Here is some information for the people that will leave to the new project. If you give this for them to read, we will have something on the basis of which we can discuss. Maybe they will have some questions. [...]

The daily context: The state has a firm control over the population. What is most striking is that the population does not seem to be very unhappy, at least not in the city of Pyongyang, but also not outside. Of course, the people in the affected areas that we saw, especially in Unpa, made a really miserable impression: they have lost their houses, lack tools to rebuild their houses, and they did not seem to get enough to eat. They face a cold winter ahead.

The State controls ALL the information from outside to inside and the other way around. There is an impressive propaganda machine that consistently communicates and interprets to the population what is happening in the world:

*provocations by the South Koreans at the DMZ

*the enemy USA plotting against them

*Japan the old enemy

*problems in other countries such as AIDS, crime, and natural disasters are used to prove that North Korea is a worker’s paradise;

We have seen no private businesses in the cities. There are only a few shops, merely for tourists. Food is distributed by the Ministry of Food. There is no bakery, no butcher. Everybody is taken care of by the State, who has a tremendous responsibility on its shoulders. The population is kept busy with futile tasks: sweeping the streets, cleaning the tunnels, constructing unnecessary public works. This keeps the population “from thinking about their fate.” But still you see many people just hanging around doing nothing. There is production and industry but probably not enough to keep everybody from the streets. The farmers can sell their crops to the state (surplus). The state sells this in a subsidised way to the population. [...]

Almost every flat building that you see has a sort of ‘health post’ on the ground floor, where people can go to for free health care. One doctor is responsible for the health of 20 families. The plan is to extend this to one doctor for 5 families. He comes to visit the family to check their health and give them advice every so many days, so also [even] when they have not called him. He makes prescriptions. Officially 85% of medicines are traditional medicines and 15% is western medicine. We did not see any western medicine available for the people during our visits to the disaster areas hospitals and clinics.

The divorce rate is said to be very low. Divorce is discouraged. Criminal punishment is rare, as most corrections are done by social pressure. It is a ‘shame culture’ rather than a ‘guilt culture’. There is real competition among the workers. The best worker gets a reward. The people are very motivated in their tasks. They are proud of their country and there are quite some things to be proud of, as you will see. They are made very conscious of the colonial past. Direct or subtle critique will not be acceptable. Critique of the government and the leadership seems totally taboo. “If the leaders say A the people say A.” [...]

The UN was never allowed to lodge or stay out of Pyongyang. Probably they have never been allowed to enter hospitals in the countryside, let alone establish a working collaboration. [...] We are the first NGO to work in Korea, in October 1995, for an emergency that started in JULY 1995. They do not understand yet fully what NGOs are and how they function. Their only experiences are with UN organisations, and businessmen. This means that we come into this country on an ‘openings move’ [relaxation of policy towards foreigners] organized by the progressive people of the government. If the experiment fails, the failure will bounce back on these reformers, and the introduction of other organizations will be further delayed. It is not sure that MSF should stay beyond the three months of this initial programme. It might well be easier for us to do an ‘excellent job’ which pleases everybody and helps the victims and makes a good impression and then get out again until a new problem arises in this country. They can then call us immediately and we will have quicker access.

Our work will be to do supervision of the County Hospital and the RI-Dong clinics in collaboration with the County Health Supervision Team. We will get translators that are doctors, who can speak English, with whom we can work and go everywhere. We cannot stay in the districts beyond Thursdays. The idea is that the MoH makes Korean translations of the prescription guidelines of MSF and sends those with the medicines to the counties. MSF has the right to monitor the drug use and ask questions about treatments and consumption. It will be interesting to see for which aliments they chose traditional medicine and for which ones they prefer western medicine.

Opportunities

There is chronic food shortage for the population, but the government has a problem admitting it, and letting foreigners monitor the situation. It would be good if gradually MSF would be the organization that would gain the trust of the local district authorities to do nutritional surveys. We could teach them how to do this. It is politically too sensitive an issue to start to discuss from the start, but after a few weeks of successful collaboration it would be good to choose a moment to bring it up simultaneously in the three districts, where MSF is working, with the local health authorities, to see how they react to the idea. [...]

Does and Don’ts

• Don’t tap on people’s heads (ask permission first);

• Don’t walk over people’s outstretched legs (make them pull them in first);

• Don’t criticize people directly (ask your colleague supervisor to explain to you why Mr X is doing this: indirect + questioning rather than judging and condemning);

• In the beginning: don’t use people’s names all the time, but preferably titles, for example, “I would like to ask Mr Hospital Director a question...” Please later find out how this issue lies in daily work? [...]

• Try to build friendship with your translators to find out more about the society;

• Always find out first with the local authorities how they feel about a new idea or an initiative that we want to take, before introducing it with the MoH. If possible, let the local authorities get permission from Pyongyang for something and avoid asking something yourself, but use the Korean counterpart instead.

• You will be listened to and bugged and translated. Never insult the head of state or makes jokes about him. All faxes that you send out of the country will be read and translated by them.

• Never shout or get angry, it will turn against you and it will only aggravate the situation. [...]

• Upon arrival you will be taken immediately to pay respect to a bronze statue of Kim II Sung, the deceased father of Kim Jong II. You have to put a flower there and look down in respect. This will be filmed by local television. Make sure you wear decent clothing.

• Never do something yourself that they can do for you. It is in general not a ‘hands on’ mission. There is no way for them to deter goods and sell them on the black market, like in other countries. I suppose they would be in serious trouble if they get caught on the offence of stealing.

• Do not take this paper with you to Korea...

DOCUMENT

”Minutes of MSF France Board of Directors Meeting, 29 September, 1995,” (in French).

Extract:

It’s the first time that North Korea has called for international assistance, following serious flooding in the country. It’s the latest completely closed country to manifest a real desire to open up. Two exploratory missions left from Thailand and Burma. After visiting the sites concerned, we proposed setting up a support project for existing facilities with 3 sections in 3 different provinces. The country is in a state of economic collapse. The personnel and health facilities are good but there are no medicines.

The draft agreement between MSF and the authorities came unglued on the presence of expatriates in the field, and the exploratory missions left Korea because expatriates weren’t accepted. Then Korea let it be known in Cambodia that expatriates would be tolerated, but not more than three nights a week in the field. This gives them control over our work and if we leave at the weekend, they can arrange meeting. […] MSF has accepted and the missions should be set up without delay. 2 planes are planned: 1 MSF Belgian and 1 MSF Bordeaux (Dutch-French). We are planning on a mission of three months with a facilitator in the capital (representing the different sections) transformed into a Head of Mission. It’s a real international section. We’ll start working in the district hospital before tackling the outlying facilities.

DOCUMENT

“Médecins Sans Frontières Responds to North Korea’s Call for Aid,” MSF Belgium, MSF France, MSF Holland, Press Release, 3 October, 1995 (in English and in French).

Extract:

Following severe summer floods, the international medical relief organization, Médecins Sans Frontières, has responded to North Korea’s call for assistance. This is the first time that the North Korean government has given authorization for a foreign organisation to launch emergency operations outside their capital, Pyongyang. Médecins Sans Frontières (MSF) will send 10 volunteers and 61 tonnes of medical and logistical supplies to North Korea. The MSF volunteers will work in the provinces of Pakchon, Huichon and Unpa, distributing medicines and basic medical equipment, Due to problems with access to clean water; there is a risk of diarrhoea outbreaks. MSF will work with local staff and authorities to follow the outbreak and carry out epidemiological surveillance.

Torrential rains in July and August 1995 caused flooding in 145 of 200 regions in North Korea. More than 5 million people were affected and 100,000 homes were destroyed. Roads, railways, health centres, medical stocks, and water supply systems have been partially destroyed. Two chartered planes with 21 and 40 tonnes of supplies for North Koreans will leave from Bordeaux, France and Ostend, Belgium. The international team will include members from France, Belgium, Holland, and Bosnia.

DOCUMENT

Minutes of the International Meeting of Operations on North Korea - 5 October, 1995, October 9, 1995 (in English).

Extract:

Were present:

-MSF H: Wilna Van Artzen

-MSF B: Mario Goethals and William Claus

-MSF F: Marc Gastellu – Jean Hervé Bradol - Martine Lochin

Subject: Organisation of coordination for the international intervention in North Korea

Decision:

-To have a common approach in front of the North Korean government for the emergency programme during the 3 months.

-To have an international “Chef de Mission” [coordinator] in Pyongyang (Hervé Isambert).

-Each team has a field coordinator who is under the national coordination of Hervé Isambert.

-To have a coherent programme

*the medical coordinator is from MSF B

*the logistic coordinator is from MSF H

*the administrator for the common pot in Pyongyang is from MSF F

-in Europe, MSF Paris will be the section, which will have the contacts with the team.

MSF F will have the responsibility for the daily monitoring of the mission and will take the daily decisions. For the important decisions (orientation of the programme, decision to stay or to leave...) it will be discussed between Pyongyang and the different sections. If they are some disagreements between the different desks, the decision will be taken by the operations directors of different sections.

The volunteers’ main activity consisted of training medical staff to use the drugs provided by MSF. The volunteers worked under the permanent monitoring of guides, minders, interpreters, and drivers provided by the North Korean authorities and could never pay an unscheduled visit to any hospital or clinic. They had no direct access to the patients.

INTERVIEW

The first time I went to North Korea, it was in October 1995, for a project that went until December 1995. We had three teams: a Dutch team, a Belgian team and a French team, and we each had one county. We were not working yet at a provincial level. Every weekend we were in Pyongyang and during the week we were in the counties. They were quite far. I think ours was about a 150 km from Pyongyang. The Dutch were in Pakchon, which is north of Pyongyang; and the Belgians were in Huichon, which was a bit further, also north, and the French were in Unpa, which is south, quite close to Pyongyang. On Monday mornings usually, we went to the county. First, we supported the county hospital. And the county hospital coordinated and supervised the clinics in the small communities, the ri-clinics [The “ri” is the smallest level of rural government, and literrally stands for “village”]. Over that period of 3 months, we have been able to be regularly in the county hospital that was our basis, where we had an office. We were able to see all the ri-clinics in the county.

And we were able to communicate with the doctors, even though we didn’t always know if the translator translated every thing we said or translated everything the doctor said. Because the translators were clearly from the State Affairs office, they were security people.

We were called in, because of the floods. But I must say that in these areas I didn’t see much flood damage. I think the areas that were affected the most by the floods; we were not allowed to go to. I think the floods were an excuse for North Korea to say: ‘Ok now we allow all help in.’ But it was clear that this country was bankrupt: the hospitals were hardly functioning, the clinics were hardly functioning, but not due to floods, just because there were no means, no money. According to them, everything was because of the floods. Medicines were destroyed. They were mainly working with herbs and we were to bring in new medicine. But a lot of the medicine they didn’t know. So we [instructed] in kinds of classes, we taught them how to use them. All the doctors of the clinics in the county came to the Pakchon and we gave them courses on how to use them. Then we went to all the clinics to see how they were using the medications and medical instruments.

We started simple, with the small kits and finally we brought in the bigger kits. The drugs came in by plane. They were stored in Pyongyang. The North Koreans are very good in logistics, better than we are. We had one logistician, a Dutch, for the logistics of all three of the teams. After one month, it was decided that he would better leave because the North Koreans wanted to do everything by themselves and they actually did it all by themselves. Some things might have disappeared but I must say, it must only be a small quantity; most of the stuff went to the places. In fact, in Pakchon, the hospital was practically empty. There was no heating: it was the middle of the winter and it was quite cold; all the mines had been flooded so they didn’t have coal, fuel, anything. That’s why the patients were at home; they didn’t stay in the hospital. We used the drugs mainly on outpatients. The beds were empty. And I must say that during the time when we were there, they started using more and more beds. But I think that feeding the patients was also a problem as there was no electricity.

You have to imagine the county team composed of two foreigners, a driver and two guides. One was a translator and the other one a guide. The guide, the translator and the driver were all from the State department. They wrote down everything that was said, and I think the driver also had an open-eye and an open-ear for everything that happened. So there were three people watching us. On Friday we came back from the field and that was when they met with the state department, and reported about what we had been doing and what we were planning next. And by Saturday evening, we had to submit a plan for the next week, and on Sunday, we would hear what would be possible and what would not be possible. And then on Monday we left again. And they had decided what we could do. And inside the county, there was hardly any possibility for any spontaneous change of plans; everything had to be done the proper way. It was clear that sometimes, in a week, we had done something that in the weekend was disapproved of, and we never had permission to do it again. Like to visit clinics more than once. In the end, we wanted to do a final round to all the clinics and do three or four clinics a day, and that was not allowed, we could only do one a day. They would never say clearly no, but they would organise everything in a way in which we couldn’t… We were bargaining continuously.

Sometimes, we went to a state shop, some of the people behind the counter would try and talk a little but usually we had a guide or a translator with us. You would never talk to a Korean without your guide and translator. Translators that got too close to the team got replaced. The three months when I was there in 1995 were really nice. I enjoyed the work. We accepted from each other that we would do it in different ways. Between MSF Belgium, MSF Holland and MSF France, there was a different approach on how to do it, but finally we managed to finish the programme. On the programme itself, we had no disagreement. We had some [differences] only on the way to do it, the sequence of things, where to start and where to end. As for MSF Holland we decided to do courses first at the county hospital. Call in all the doctors and then, after the course, distribute and supervise. MSF Belgium went to every clinic, did a short course for the staff then went back again. Then they went to another clinic, did a short course, which was very time consuming. Thus they didn’t have time to see how things were used. In MSF Holland, we chose to centrally give courses, then distribute, then go around and see how they’re using it.

[...], Physician, MSF Programme in DPRK, September to December 1995, January 1997, June 1997.

On 21 November 1995, the press agency ‘Agence France Presse’ issued an article supposedly based on an MSF alarmist ‘report’ and on an interview with an ‘MSF representative’, regarding the consequences of floods in North Korea. In fact, the ICRC had issued the report, and the MSF ‘representative’ was an MSF Japan employee whose remarks had been misrepresented.

DOCUMENT

“North Korea Devastated by Floods, Humanitarian Group Reports,” Pierre-Antoine Donnet, AFP (France), 21 November, 1995 (in French and in English).

Extract:

Huge swathes of farmland have been destroyed in North Korea by flooding and the communist state faces a serious crisis, a leading international relief group said Tuedsay. ”There has been enormous material damage,” said Frank Boquet of the Médecins sans Frontières group, which has had a team in North Korea for two months. According to statistics released by the French-based medical group, around 400,000 hectares (one million acres) of arable land have been wiped out by the floods that struck 145 of the isolated state’s 200 regions during the summer. The group said around five million people had been affected but that it was impossible to estimate the number of dead and injured. “Hundreds, perhaps thousands, we don’t know,” said Boquet. “But a large number of villages were swept away in landslides,” said the Médecins sans Frontières representative. Boquet added that in a 150-kilometre (95-mile) zone around the North Korean capital Pyongyang did not seem to have been any epidemic or serious food shortages. “The situation does not seem to have reached really catastrophic proportions,” he commented, while adding that there were serious shortages of medicines.

North Korea has made deals with South Korea and Japan for the grant or purchase at favourable terms of hundreds of thousands of tonnes of emergency rice. South Korean officials have said they suspect there is a serious food crisis in the North. Médecins sans Frontières have had a 10-person team in North Korea since October, an unprecedented mission in the tightly sealed-off country now ruled by Kim Jong-II, son of the country’s former “Great Leader” Kim II Sung who died last year. The North Korean authorities approached the French humanitarian assistance group for help.

DOCUMENT

Fax from Hervé Isambert, MSF coordinator in North Korea to Martine Lochin, Wilna Van Aartsen, William Claus, Programme manager, 22 November, 1995 (in French).

Extract:

Received your fax concerning the two AFP releases.

Here’s what I think: [...] I think that the state of affairs he presents is drawn from the conclusions of the explo mission and not from the present mission. […]

3. Concerning the communication itself, I don’t think it will cause too many problems: a call for international aid by organisations present in the field seems increasingly necessary if we want to raise donor awareness and collect funds. Certain members of the government are starting to understand this and the WFP is working on the question. It (WFP) has asked me if I would accept to give an interview, I replied that I would, following authorisation from the Korean committee. But it’s too early to say anything yet: WFP needs to obtain the committee’s approbation first, then, I’ll contact you about it immediately. So more on this point soon.

4. The contents aren’t completely false but be warned; the number one problem remains food. We can’t say that there’s a serious lack of food because we don’t see Somali children yet! The damage really was catastrophic, the WFP has asked for a joint valuation with the FAO to get an objective idea of its scale. The remaining food in stock has allowed the last few distributions to take place, which prevents the global state of malnutrition becoming visible to the “naked eye” for the time being. We’re currently working on raising Korean paediatric teams’ awareness on the detection of infantile malnutrition and taking adapted measures, if necessary. We cannot therefore say anything about malnutrition at the moment.

There’s an incontestable shortage of medicines and needs have heightened since the floods.

The Koreans are expending considerable energy dealing with this catastrophe. A lot of rehabilitation work (reconstruction of houses, etc.) has already been done but the country needs food and healthcare; it’s incontestable.

In conclusion: this paper should not be a big problem but it’s always better, especially in this delicate context, to hold precautionary consultations with the Paris headquarters.

DOCUMENT

“Regrets and Contrition” Message from Dominique Leguiller, MSF Japan Executive Director to Marc Gastellu-Etchegory, MSF France Deputy Director of Operations, 24 November, 1995 (in French).

Extract:

Hi Marc,

Thanks for the fax that we were waiting for, cringing […]. Clarifications, which you probably already suspect. I should point out that we’re not trying to contact Korea; we just answer the telephone, that’s all […]. The general style of the AFP fax clearly indicates that all information on North Korea comes from (Dr) Franck. Franck cited information contained in sitrep n° 1, which the journalist was too quick to attribute to MSF (certain information being the ‘official’ information circulated by North Korea itself). Franck didn’t say: “There’s enormous material damage,” for example, he didn’t talk about landslides, or shortages of medicines, and above all about shortages concerning ‘minor pathologies’.

As the fax has been circulated and AFP is a serious outfit, it is of course impossible to withdraw this information. I had to make do with sharing this morning’s angry exchange with the AFP boss. It should be noted that normally all Japanese journalists have texts re-read before their circulation (which was the case of P. Pons of Le Monde, for example), which the AFP journalist didn’t do [...]. In conclusion, I think we were set up. Please be assured of our contrition, believe us that we’ll never do it again and accept our profound apologies. [...] When the BBC called me the same evening, I took the liberty of not replying, and kindly gave them your name instead. I’ve asked all my colleagues to pass all calls concerning Korea directly to me directly. At the moment, there’s been 1) the BBC and 2) a Korean journalist.

On 11 December 1995, the director of WFP in North Korea warned that the country was in danger of a widespread famine, while there was no food aid arriving. The reality of the emergency was challenged by the South Korean authorities. They suspected that the DPRK was exaggerating the seriousness of the situation in order to obtain more international aid.

DOCUMENT

“Half a Million North Koreans Threatened with Famine” Philippe Pons, Le Monde, (France), 15 December, 1995 (in French).

Extract:

Risk of famine in North Korea? Over the last three years, the country has been going through severe economic crisis following the dismantling of the USSR, which translates into, amongst others explanations, as food shortages. The ‘Hermit Kingdom’, fallen prey to the inefficiency of its collective system, is particularly lacking fertiliser, insecticides, and fuel. These gaps have been aggravated by the catastrophic floods of last summer. Experts are divided about the scale of the disaster, and its consequences. Whilst the representatives of the World Food Programme (WFP) are sounding the alarm, signalling famine, the South Korean authorities tend to minimise the situation. These divergences create a climate of tension between Seoul and Washington and paralyse the delivery of aid.

According to the WFP representative in North Korea (DPRK): “There is an emergency food situation;” Trevor Page has seen rural populations searching for roots in areas where the land was carried away by floods in the Huanghei province. It also notes the absence of cabbage practically everywhere in the south of the DPRK which, when fermented, forms the staple seasoning of Korean food. According to Médecins Sans Frontières, the catastrophe affects the most important elements of the health system, and food and water supplies in the country; it notes the lack of medicines in particular.

[…] It’s not easy to check the figures put forward by Pyongyang; 5 million out of 23 million people homeless, and 15 billion US$ worth of damage. Most experts estimate that 400,000 hectares have been destroyed and 500,000 people have lost their homes. A representative of the International Committee of the Red Cross (ICRC), Calvi Parisette, who has just spent a month there, observed symptoms of malnutrition. According to Bernard Krisher, an independent American journalist based in Tokyo, who has just returned from North Korea, without the emergency food care provided by WHO - the first delivery arrived on the 23rd November - “There will be a famine by December.” Mr Page estimates that these 5.1 tonnes of food are largely insufficient. […]

The annual rations of rice have been cut in half since the floods. Dropping from 340 to 150 kilos, the individual rations do not reach the minimum of 450 grams of rice per day fixed by the WFP. In a country of harsh winters, the situation for the homeless population is alarming. International organisations, nonetheless, note the population’s relative confidence in support from the state, which seems, despite the poverty of its infrastructures, to be coping with the situation, except in terms of food. According to South Korean experts, the North need 6.7 million tonnes of cereal; this year, it can only respond to 60% of the needs.

[…] According to Kim Hyung-hi, Vice Minister of National Unification in Seoul, the international organisations’ estimations of damage suffered by the North just reuse the figures produced by Pyongyang, which exacerbates the difficulties in providing more aid. According to him, the North want its population to believe that the floods are responsible for the shortage, and not the regime.

DOCUMENT

“A Killer Winter – The Isolated Regime Desperately Needs Food Aid but Doesn’t Know How to Ask,” Tony Emerson, Newsweek (USA), 18 December, 1995 (in English).

Extract:

When the skies opened this summer, no one foresaw that mere rain could erode the barriers that have isolated North Korea for five decades. But so it has. The worst flooding of the century has forced Pyongyang to issue its first, reluctant call for international aid. Now foreign relief workers have fanned out across a nation that traditionally confines guests to the showcase capital. Prompted by Washington, which is eager to forestall a collapse of the North Korean economy, about half a dozen private U.S. organizations are delivering everything from milk powder to dental supplies. In a country still wary of foreigners, with erratic passenger and frights connections to the outside world, succor is a struggle. [...]

Yet the picture of North Korea is still far from complete. In interviews, relief workers paint a far bleaker tableau of desperate hunger and widespread devastation. The floods destroyed up to one third of an already weak grain harvest; leaving North Korea 40 percent short of its total grain needs this year. Trevor Page, Head of the new U.N. World Food Program (WFP) office in Pyongyang, says that during a trip to north Hwanghae province in late November, he saw “old wizened elderly women, on their hands and knees in newly ploughed paddy fields, trying to find roots for the family soup pot.” Earlier the same month, Peter Lee, coordinator of the private relief group MAP Asia, watched children in Hwanghae province walking in hail and freezing temperatures without coats or socks.

The relief campaign is falling short. A WFP assessment concluded that half a million people had been displaced in a population of 22 million. Of those, 55,000 are under the age of 5. “The children appeared wasted and stunted” as even colder weather approaches, said the WFP. [...] “The offers of assistance have not exactly been overwhelming,” says WFP official Michael Ross. “North Korea is not the most popular place in the world right now.” No, it’s not. At first, both South Korea and Japan offered major shipments of rice aid. But Pyongyang has proven a most prickly supplicant, sustaining blistering attacks on Seoul and Washington even as it suffers.

After its September plea for aid, North Korea seized a South Korean ship that had delivered a load of rice, and detained the ship’s crew. Seoul claims North Korea sent armed infiltrators into South Korea. Pyongyang continued to make new financial demands in its negotiations with Washington on abandoning its suspected nuclear weapons program. And South Korean President Kim Young Sam recently charged that North Korea was massing warplanes near the border.

Because of unresolved tensions, neither Seoul nor Washington has given North Korea substantial relief funding. To help make up for the shortfall in government aid bequests, Washington has quietly encouraged private organizations to step into the breach. But South Korea has dug in, refusing to encourage any aid until Pyongyang asks it directly. Following South Korea’s lead, Japan halted government aid as well. The result: this winter threatens to bring North Korea closer than ever to the collapse both Seoul and Washington desperately hope to avoid. In some northern provinces, says Page, there is already “acute malnutrition” and rations of cabbage have fallen from 120 kilos to under 20 kilos per person this year.

Meanwhile, North Korea has welcomed its new private benefactors in typically erratic style. International groups like the Red Cross have been given full access to the countryside. […] One food shipment was greeted by a live pop band. Other groups, like France’s Médecins sans Frontières, remain uncertain whether Pyongyang will even allow them to stay. “The basic problem is that North Korea, as ever, has no consistent policy on admitting foreigners, even at a time of need,” says Barron.

In late December 1995, while the three-month long programme was coming to an end, the MSF team in Pyongyang, together with the Programme managers, started to think about a new program, and commenced discussions with the DPRK authorities. The UN agencies, foreseeing a further deterioration in the nutrition situation in North Korea, were trying hard to convince MSF to remain involved in the country.

DOCUMENT

Sitrep n°8. Fax from Hervé Isambert, MSF in Pyongyang (DPRK) to MSF B, F, H Programme managers, 24 December, 1995 (in English).

Extract:

General

Everything has been going well to prepare the soon departure of the team. You got already some time schedule information. They spent past two weeks visiting other fields and finishing their current activities.

UN agencies meeting

Last week Marcel then this week Maarten attended the UN meeting. Nothing really new except that before leaving to Roma for Christmas, Trevor Page expressed again very strongly his concern about the food situation in the country and gave some telephonic interviews. He said that without any prompt response of the international community the WFP will have to withdraw from the country which would be dramatic [...]. Marcel announced ‘officially’ our soon departure. The agencies reaction was unanimous lo express their wish to see us staying as they were concerned in view of the further deteriorating conditions in the country. Marcel explained our present situation: we committed ourselves with a three-month contract, which is ending very soon now.

He added that we told already to the committee our willingness to resume MSF activities in DPRK just after the closure of the current programme, as we remain very concerned with the general health-nutritional situation of Korean people. He said we are ready to continue our part in the international relief assistance operation but we didn’t get any positive answer yet neither any positive sign from the committee side.

UNDP proposed a common approach from their side in writing a letter to the Government explaining the needed complementary work between UN and NGO agencies. Maarteen and I met WFP just before their departure, T. Page tried again to persuade us to stay and stressed the fact he needed our work to convince the donors. We insured him that if we reach, [by the] beginning of January, a new agreement with the Committee we will proceed straight with a new assistance programme focusing more on the nutritional status monitoring. [...] He told me all the good impression the government has about our humanitarian work and their best understanding of the word ‘humanitarian’ which includes the personal involvement of volunteers. He said although he was not hoping [for] a new disaster, but in case it might happen again, we would be the first one to be requested for help. He reminded the principle of self-reliance which conducts the political main lines of the country but doesn’t exclude the international help in case of such disasters.

Then, he said that many different parts both national (the diplomatic representation in Paris) and international (UNDP, DHA, WFP) asked him to allow us to stay and take part in the monitoring of food relief assistance in the country. He said it was OK for him but as long as there is still no food to distribute in spite of the appeal sent already, he doesn’t see what we could to as long as it is not medicine tablets which can feed the people. I explained that when a lack of food becomes a problem that means it becomes a health problem. The monitoring of the nutritional status happens to be compulsory. It is the only way to early detect and then to take appropriate action on time. It was the reason why we proposed to help the Ministry of Public Health in doing a survey. The experience of MSF in conducting such survey is internationally recognised and it is indeed worthwhile to convince the donors in providing funds for food relief. And then, the fact is that [it] will be very difficult for us to justify [to] the international community our departure from the country while the current food situation requires an international assistance. [...]

I introduced our part in the negotiation of a new memorandum. This is right on time to start now as the committee seems to being looking forward [at] what could be our new commitment with them. On the other hand, WFP is urging us to take action in helping them.

After discussions with Maarten and Martine (be careful with the two different pronunciations) here is roughly the new programme we could propose.

The objectives should focus two axes:

1/Nutrition:

-To early detect a deterioration of the nutritional status

-To feed the detected undernourished children with appropriate food.

-To minimise in intensity and duration, the repercussion of the lack of food relief to come.

2/Health:

-To early detect and prevent any epidemics due to the current precarious situation after the floods (lack of flood, lack of heating system).

-To ensure the drug supply able to cure 80% of the pathologies in health facilities covered by the programme.

Activities:

-To cooperate with the Ministry of Public Health in organising and monitoring nutritional surveys as to provide an international acknowledgement and make the international community [aware of] with the current and acute food problem. [...]

-To propose and collect some basic epidemiological data in order to detect the common outbreaks that might occur in such situation.

Location:

After an exploratory assessment, we could propose a similar programme as the former one in a new county. The three counties where we have been working would be included as to continue the following up of health and nutrition indicator. The essential drugs supply could be provided if still needed. Therapeutic feeding centres should be set up in each paediatric unit at beginning. If necessary and after reliable [data] collected by our team, a general food distribution for under 5’s should be implemented on a large scale.

Comments:

In spite of the international appeal launched by the UN, there is almost no response yet. If the lack of food is severe, as it seems to be, there will be soon repercussions toward the nutritional status of under fives. If we are in position to early detect it, we will be able to raise our voice with undeniable arguments and convince the international community. This is of course our main reason to stay. At the same time it would be worthwhile to prepare ourselves for an emergency food relief assistance programme with the newly born MSF department. The information delivered by the WFP about the food relief makes us worried: no real response can be expected before proof of needs. That’s one of the main reasons why they need us to stay. Then the compulsory delay between a finally heard appeal and the food digested in people stomachs could be shortened if we would be able to provide emergency food for general distribution at least toward the under fives. OK we know this can be previewed just if we are able to make at first a real monitoring of the nutritional situation. We’ll try to make the committee understood of the absolute necessity of it but anyway that is of course up to them.

DOCUMENT

Sitrep n°9. Fax from Hervé Isambert, MSF in Pyongyang (DPRK) to MSF B, F, H Programme managers, 25 December, 1995 (in English).

Extract:

New negotiations were officially started with the Chairman of the committee this morning and I prefer to keep you informed as soon as we are getting new information. First of all, as expected before it has been clearly said this morning that there should be no confusion between the current project and any future plans. We assured that it was also our goal to finish everything related to the current project before the 6th of January, deadline of the contract. We introduced what could be our future objectives and activities for a new programme in DPRK, as already described in the sitrep n°8. They said that the door was not closed but they think they made a lot of concessions already to allow assessments from different organisations and they received little assistance only...

They need more guarantees from us even if they expressed their satisfaction with the former programme. We expressed our wish to be seen by them from now on more as partner than just donor: a partner who has indeed in his hands even more resources than just the guarantee in term of his available funds. The fact is this is not clear yet. They are still confusing NGO with UN and donors. In this regard we are trying to write a paper to explain better the part of the different partners in relief assistance. We’ll meet again soon. During this while it would be useful to keep contact with the DPRK representation office in Paris to inform them directly about what MSF is ready to do in the future. You know that we would prefer (as you would for sure!) to reach an agreement before our departure as otherwise it will take a long time and cost more money. In a certain way, this is a real emergency to take action in need of professional monitoring if we want to minimise the repercussion of the possible starvation to come... We will try our best.

DOCUMENT

Sitrep n°10, fax from Maarten Groot, Hervé Isambert, MSF in Pyongyang (North Korea) to MSF B, F, H Programme managers, 29 December, 1995 (in English).

Extract:

We feel a bit worried that with this new idea (general food distribution), we could lose our main line: the part that we usually have to play in this kind of situation. Maybe some clarification is needed from our side.

1-There is a real need of food. Even though it is not yet documented in terms of repercussions it might have for the population, everybody agrees on that. But at the moment the government doesn’t consider the situation serious enough to do more in terms of facilitating the work of international aid agencies as far as monitoring of the nutritional status is concerned. We are trying to convince them that it is the only way to get from the international community a proper response and beyond that to be aware of the actual severity of the problem for a better monitoring in the future.

2-There is a precarious health situation, which is still in need to be monitored and supported. The winter is here, many heating systems are still not functioning and the outside temperature is going down to minus 5 to 10 degrees, diarrhoea is still a problem in many places... except for the government no one else can really say that the health situation is under control.

There is an obvious role for MSF to assist the DPRK in the activities we are used to run. At present, we are leaving the country because the DPRK government doesn’t see the necessity for our technical help at this moment. In case of need, however, they leave the door open for the future. Then, we are conducting negotiations and we are still hopeful to reach an agreement. We agreed with Martine and William to give us a chance up to the 15th of January. In a new agreement we have to be seen as a real partner and not as just a convenient donor. We are now in a better position after introducing ourselves (it was one of the main objectives of our former mission). This is probably not enough but there are also some other things which will certainly be in our favour: at first the unanimous opinion of other international agencies, which we would prefer not to be expressed in terms of pressure but more in terms of a necessary partnership, and then the negative impact our departure will have on the international community which is inevitable and which, as we indirectly heard, has been expressed already without any request from our side (you may have heard more about this on your side as well).

DOCUMENT

“North Korea,” Letter from Wilna Van Aartzen, MSF Holland Programme managers to Martine Lochin, MSF France Programme manager, 29 December, 1995 (in English).

Extract:

Herewith my reaction on Hervé’s fax. He should continue pushing the government for:

1) Monitoring and surveillance of nutritional status. Indeed the only way to trigger a response (= donor assistance). Without hard figures no donor response to be expected.

2) Health situation to be monitored and health assistance by MSF.

3) Our departure is the wrong signal to the international community (try to make that very clear to the government).

On general food distribution: in the given circumstances, that is no data, no observation by our teams of serious malnourishment yet (that might come). […] The opinion of the team (Hervé, Maarteen) is in the same direction. They even fear confusion and loosing our credibility. This is for me essential, and this factor therefore conclusive. Besides, we should not stay out on strategic reasons when a general food distribution [is] staying for strategical: OK but then not with a programme, which is so vulnerable for manipulation, which food is. I like to suggest that if we do not reach an agreement before 15.01.96, Hervé already negotiates a visit of MSF in about 2 months (March?) by Mauritz and one of us (me).

INTERVIEW

We had expected a bad nutritional status; what we saw amongst children was signs of chronic malnutrition but not of acute malnutrition. And in fact, after one month in the counties, we started thinking that a malnutrition survey was necessary. That was immediately the point when the North Koreans told us: ‘The project is only three months, we will not extend it.’ I think the words “nutritional survey” were the last drop for them. As soon as we were in the counties and they noticed the kind of conversations we were having with the people, I think that for them, it was clear that it would not continue at a county level: we were seeing too much and hearing too much. So that was a very sensitive issue; and they never wanted to talk about it. We have repeated it many times but that was a no-go area. At the end, the 2 or 3 weeks, Hervé and I escaped the hotel when we walked through Pyongyang, and when we came back they were worrie:’Where have you been?’ We walked a lot. You see the empty boulevards and the occasional Mercedes-Benz, people who don’t dare to look at you, it’s a bit unreal, it’s a huge city, it’s big, looks well developed, but there’s hardly any life in Pyongyang, unless it’s organised. You see people doing gymnastics on the big squares, but that’s organised, you don’t see people doing things by themselves, or just walk.

[...], Physician, MSF Programme in DPRK, September to December 1995, January 1997, June 1997.

In early January 1996, the MSF team in Pyongyang proposed further emergency action to the DRPK authorities, one that would link nutritional and medical activities. However, this proposal and another proposal to conduct a nutritional survey were refused by the DPRK authorities. Thus the MoU was not extended. On 20 February, 1996, the last MSF expatriates left the country. Nevertheless, MSF kept on monitoring the possibilities to come back to North Korea.

DOCUMENT

”Proposition for an Emergency Action in Democratic People’s Republic of Korea,” Médecins Sans Frontières, January 1996 (in English).

Extract:

From October to December 1995 Médecins Sans Frontières teams have appreciated working with the authorities and with the medical staff of the provinces of Unpa, Huichon and Pakchon. Because Médecins Sans Frontières is a medical and humanitarian organisation, it needs to express its worries about the nutritional and sanitary situation for the coming months. Médecins Sans Frontières also proposes an action.

Nutritional situation

The floods of last summer 1995 have massively destroyed the agriculture. That is mainly why there is an urgent need for food. This need is acknowledged by the government as well as in the last report of the World Food Programme. The consequence of this lack is the rapidly increasing malnutrition among the children under 5. This pathology needs medical treatment adapted to its different manifestations. Nowadays, some cases of malnutrition have already been identified in the hospitals where Médecins Sans Frontières has been working. The Korean medical staff has been trained to recognise malnutrition but this action is not sufficient if there is not a follow up of the nutritional status and good care of the malnourished children.

This action has to be reinforced by a food distribution to under five children to prevent the occurrence of malnutrition. If the lack of food confirms and remains we fear that the number of malnourished children will increase. The next crop will be harvested in September 1996, the nine coming months will be difficult to live through for the Korean children.

Medical situation

During the floods, some health structures, pharmacies and medical material have been damaged or destroyed. The main pathology after this disaster was diarrhoeal diseases. Médecins Sans Frontières medical teams have met the lack of essential drugs and medical; material. The priority was to supply health structures, which were starting their activity again and to train the Korean medical staff to the use of drugs. Due to the very cold winter and lack of drinkable water in certain places, pathologies such as respiratory track infections and diarrhoea are increasing. These pathologies hit first the children and among them principally the malnourished. The winter is lasting until end of April. The food available in the three provinces where Médecins Sans Frontières has been working will last only until the end of February 1996. The Korean medicine assures 50 per cent of the drugs needed but a need for essential drugs and particularly antibiotics remains.

Propositions of action

To reduce mortality and morbidity caused by malnutrition and others pathologies worsened by the winter.

1. Care and prevention of malnutrition

-To evaluate the malnutrition among children to obtain a malnutrition rate and to be able to follow its evolution.

-To detect precariously malnourished children and to take care of them by training the medical and paramedical staff. To supply drugs and special food.

-To prevent malnutrition by organising a food distribution for children under five.

2. Need of essential drugs

-To carry on Médecins Sans Frontières’ action in the three provinces and to widen it to other parts of the country where needs are important too.

Conclusion

If Médecins Sans Frontières’ teams notice that the nutritional situation is rapidly worsening Médecins Sans Frontières could be involved in a general food distribution. Since Médecins Sans Frontières’ action in emergency situations is appreciated by the International Institutions it will be able to bring awareness to donors and to the International Community about the needs in Korea. Médecins Sans Frontières will work in collaboration with the Korean authorities and the Korean Ministry of Health. In 1995, Médecins Sans Frontières has been working in 64 countries with 2,950 volunteers in the field and a budget of 300 million US dollars.

DOCUMENT

Sitrep n°14 bis. Fax from Maarten Groot, Hervé Isambert, MSF in Pyongyang (DPRK), sent from Beijing (China) to MSF B, F, H Programme managers, 29 December, 1995 (in English).

Extract:

As from 20-01-96, we are back in Beijing […] Our last week in Pyongyang. We left Pyongyang with strong negative feelings as far as the last week: our wishes as far as the final distribution visits, as agreed upon before, were not respected, our position as MSF representatives for the negotiations was ignored and ‘facilitation of our work’ meant for our (new) counterpart clearly to facilitate our early departure.

In some more detail:

Immediately upon our return from Beijing we discussed with the (new) counterpart and the translator our wishes and agenda for the week and the fact that we had two mandates: finish the distribution and represent MSF in further discussions about possible new MSF assistance. As far as the distribution visits to the 3 countries we can be short. We were taken around as puppets, being just delivery men, meeting people who had been clearly instructed what to say and what not. The agreement that a medical translator would accompany us to discuss the experience/use of Ketamine and possible other medical subjects, was at the last moment not honoured. Protests from our side about this were said to be upsetting and a threat for future cooperation. No apologies, just that we should appreciate their assistance. It was an anti-climax and king of a humiliating experience. We decided to get it over with as soon as possible and were back in Pyongyang on Wednesday evening.

Information we did get during our ‘discussions’ was that in Huichon the paediatric department of the factory hospital was closed because of the heating problems and that they treated until now 90 children (out of the 700 children they are responsible for?) <80%. In Pakchon the number was 27 children. The day after finishing the distribution we waited in vain for our counterpart and the car, which reminded us of the time our telephone and fax line were disconnected, one day earlier than agreed, immediately after signing the handing over of the cars to the government. Positive side of this was that we enjoyed a ‘free!’ day on foot in Pyongyang.

We were informed later that the Committee chairman had been trying to see us during that time (???). Our agenda, which was discussed repeatedly, was disrespected again the day before our departure. When getting ready for the weekly UNDP meeting we were informed that the Chairman of the committee was on his way to meet us. The meeting was an open discussion. The Chairman mentioned the clear disapproval of the government to see food and health problems linked together. Their opinion is that all the funds available for DPRK should be used to respond to their food needs. They understand our rules but we need more flexibility to adapt ourselves if we want to reach an agreement. He clearly said that the voice of the developing countries was not taken enough into consideration by the rich countries and as we have the Government as counterpart, we should respect it – they have their own nutrition unit, which can supply us, better than anyone else, with the necessary figures or information).

He mentioned also that in the former project, some agreements he made during the discussion with the MSF negotiator have been denied by our team and explained that he was talking about our presence at Ri level while it was agreed before that we would work at county level (according to him this was the source of the Unpa problems, which surprised us, since it was never explained like that before and we did not have these problems in Huichon or Pakchon). He mentioned the disappointment of the people in Huichon after they showed us their water problems, not to see us coming with solutions. Then he said again that the general conclusion of the Government about our former program was good and that they hope MSF may provide future assistance to their country. The papers given by headquarters to the representation in Paris are being studied at the moment. Their criticism is that they do not mention a total amount of US$ for a specific time period and the number of expats needed. They prefer to negotiate further through Paris and expect that an action from our side will start soon after we get their approval and that a report from their nutrition department together with the WFP/FAO will be good enough for us to start (they don’t like assessments).

We answered to the different remarks:

That the papers received through Paris were meant as explanation and as possible options for MSF assistance and not as a programme proposal, which can only be written after open discussions and suggestions from both parties. MSF is first of all a health organisation, however, ready to address a food problem when it becomes a health problem (including food distribution). As far as MSF, assistance is discussed in terms of meeting the needs of the affected population. After a mutually agreed program proposal the price will be calculated. Funds usually come from other sources than the ones of other agencies. We expressed to them again the MSF concern for the Korean people and that we will be ready to discuss anytime (even right now) a further programme. [...]

Conclusions after this week:

These are the comments we can make right now. From remarks and meetings, it is clear to us that the strongest objection against MSF is that we work at field level. Also our attention for children is not really ‘appreciated’. They expressed their appreciation, however, for our ‘good work’ and our ‘sincerity’. But it is clear, once again, that the government thinks of assistance only in terms of dollars and not in terms of actual assistance to the affected population. When the chairman mentioned, “agreements denied by MSF” and “different opinions within MSF,” he clearly hinted to the US$ 1,000,000, which was not fully delivered. This may be the reason why they prefer to negotiate directly with Paris or to receive another negotiating team, like the previous one, which is willing to talk in terms of dollars and cars. We think that we (Paris and us) have done enough now in trying to discuss with the DPRK government for the time being. We have to wait for their suggestions except if we are willing to propose them something new or compromise ourselves (but are we?). You can guess our answer... Certainly, the situation is critical and it is our duty to prepare for a new assistance program but not at any price. There is a specific role for MSF, if we cannot do it, it should not be because of lack of interest from our side. A strategy has to be drawn, a recommendation paper will follow.

Bye, Maarten & Hervé.

INTERVIEW

In fact, the first project was kind of a continuation of the exploratory mission. That’s also why we had hoped to continue after three months. We would have liked to continue and expand but the North Korean government said: ‘No, we want the course, the medication, but when the project is over, you go.’ Hervé Isambert [the Coordinator] and me, we stayed two or three weeks longer. During these two weeks, we distributed the last items we had in the stores, then they wanted the keys to the cars, the whole thing was over, it was clear. In Beijing at that time there was a South Korean journalist and there was a lot of people in South Korea, in favour of sending assistance to North Korea. So they were very interested in what the situation was like in North Korea. Hervé talked with this journalist. But because we wanted to continue, we didn’t want to stir [things] up.

[...], Physician, MSF Programme in DPRK, September to December 1995, January 1997, June 1997.

In early February 1996, at a time when the USA, Japan, and South Korea had just announced a decision to deliver food aid to North Korea, the North Korean authorities asked relief organisations to stop appeals for food assistance to flood victims. The MSF Coordinator in North Korea stated to the press that though one couldn’t yet talk about a famine, the nutritional situation in North Korea was serious and should be quickly addressed.

DOCUMENT

“North Korea Renounces Aid Destined to Relieve its Food Shortage,” Philippe Pons, Le Monde (France) 11 February, 1996 (in French).

Extract:

The politicisation of aid destined to relieve North Korea of the serious food shortage gripping the country has provoked stiffening attitudes amongst the Pyongyang authorities. The North Korean ambassador for the UN, Pak Gil-yon, confirmed to the Japanese press agency Kyodo on Thursday 8th February that his country will no longer request assistance from the international community as long as the interference from ‘hostile elements’ persists. He accused South Korea and Japan of blocking aid to his country. The hardening of the Democratic People’s Republic of Korea (DPRK) which, after serious floods this summer, had turned for the first time to the international community for assistance appears to indicate a return to the entrenchment which has characterised the world’s last remaining Stalinist regime in the past.

[…] Last Thursday’s resumption of American and South Korean military exercises, set to continue until March, has no doubt played a role in this hardening attitude. Yet Pyongyang does accept the aid already committed, particularly the 2 million dollars accorded by Washington at the end of last week. Washington’s decision to provide this assistance, against the advice of its Korean and Japanese allies, was meant to break open a vicious circle of procrastination and controversy regarding the North Korean food crises by recognising the gravity of the situation. This American assistance, which will be delivered via the United Nations’ World Food Programme (WFP), will be added to the contribution of 1.9 million dollars supplied by European countries. These combined contributions amount to half of the 8.8 million dollars emergency request by the WFP, which considers that 2.5 million women and children are suffering from malnutrition in the DPRK.

This summer’s floods aggravated a chronic shortage. […] Seoul has played down the scale of the disaster. It’s not impossible, on the contrary even, that Pyongyang is trying to obtain as much foreign manna as possible by dramatising the situation. Nonetheless, humanitarian organisations that have been to the DPRK are unanimous in recognising the gravity of the situation and pointing out the risks if it deteriorates. […]

The testimony of Médecins Sans Frontières:

According to Doctor Hervé Isambert, Head of Mission for the French non-governmental organisation Médecins Sans Frontières in North Korea, who has just spent three months in the country, “whilst we can’t yet talk about a famine – I saw no one dying of hunger - the malnutrition and under-nourishment are very much in evidence: “Given the Siberian cold currently reigning in North Korea, the children - and some of them were presenting signs of malnutrition in November - are threatened by pulmonary infections. Once we’ve reached this point, the situation will rapidly become dramatic. We shouldn’t wait until the children are in really bad shape before intervening. The situation is certainly not like certain countries in Africa, but it’s potentially as serious. The big difference is that when we can actually see it, we’ll already be on the edge of a precipice.”

From 30 April to 22 May, 1996, under invitation by the DPRK representative in Paris, an MSF International team of three volunteers undertook an exploratory mission in North Korea. However, they were not free to move around as they wished. Once again, negotiations about a possible MSF nutritional-medical programme stumbled over the North Korean authorities’ strong desire to receive huge amounts of food aid without any expatriate to monitor its delivery. Some members of the MSF France Board of Directors expressed their opposition to what they described as: “Collaboration with a totalitarian regime.”

DOCUMENT

Report “Exploratory Mission to DPRK, April 30 – 22 May, 1996, MSF International Mission,” Georges Dutreix, Monique Peerden, Hervé Isambert, (in English).

Extract:

Introduction:

In April 1996, the government of the DPRK (Democratic People’s Republic of Korea) invited MSF via their representative in Paris, Mr Kim, to visit the DPRK again. On April 30, an international MSF mission arrived in Pyongyang. The objectives were:

-To continue the discussion with the government about possible interventions by MSF based on the MSF report after the previous mission.

-To target the most vulnerable groups regarding nutritional status, presumed to be the children under five, especially those who are not attending nurseries.

-To come to a programme proposal and agreement with the government and to start up this assistance programme when possible.

Several meetings were held with the Committee of Rehabilitation after the Flood Damage (CRFD) [Flood Damage Rehabilitaiton Committee – FDRC], with different UN departments present in the DPRK (WFP, UNDP, UNICEF), and one visit was made to Huichon city (meeting with the Vice Chairman of the county, Director of Public Health of the county and the Director of Huichon City Hospital). There have been no meetings with paediatricians or family doctors. Also meeting the Ministry of Public Health in Pyongyang was not possible.

Results of explo-mission

-From information of the government and the UN it became clear that the nutritional situation in the country is bad, that it will get worse in the coming months because the government is not able to provide enough food to the Public Distribution System, the pipeline of food assistance by donors is becoming dry and the harvest is delayed because of the late spring time. The nutritional condition of the population will seriously deteriorate to an alarming level if the situation continues as it is now.

-General food assistance is needed to supply the Public Distribution System.

-It was not possible to do any kind of nutritional survey, so vulnerable groups are not targeted.

-During the field visit to Huichon the idea came up that MSF could start an assistance programme of food distribution to hospitalised patients, in combination with supplying essential drugs and giving support to the nutritional and epidemiological surveillance System.

MoU

After discussions with MSF headquarters in Europe the proposal was laid down in a new Memorandum of Understanding (MoU) which was offered to the Chairman of CRFD, Mr. Jong Yun Hyong, being the representative of the government for negotiations with MSF.

Basically the programme proposal concerns:

-Nutritional and medical assistance to health facilities in Huichon and Pakchon counties.

-Food distribution to another 8,000 hospitalised patients in different hospitals in the country, preferably in the vulnerable areas, meaning North Pyongyan and Chagang provinces, along the Chinese border.

-Cooperation between local health workers and MSF expats (1 nutritionist, 1 medical doctor and 1 logistician administrator on capital level) to support the nutritional and medical surveillance system and exchange knowledge with Korean doctors. [...]

Office in the country

The main point of discussion was the difficulty the government has with the condition included in the MoU that MSF wants to have an office in the country, in Pyongyang. Because the presence of NGOs in the DPRK is not included in any law, this condition is unacceptable. Although the government recognises the needs of its population and is grateful to the offer of assistance that MSF is willing to give, they are very reserved to permit organisations being in the country and having many foreigners on a permanent base. They explained that they are proud people who rather refuse assistance than breaking their rules and regulations. The government prefers MSF to open an office somewhere else, for example in Beijing, and to come for regular visits to monitor the programme (like Caritas is doing). This is also based on their bad experience with some organisations that visited the country during the past months, which collected all kinds of sensitive information. According to Mr Jong the political situation in the country is very sensitive and tense at the moment regarding the continuous attacks by South Korea and the US on North Korea, so they cannot afford to have more spies in the country. Although they understand very well that this is not the case with MSF, they are afraid that if they allow MSF to stay permanently in the country that they cannot refuse that to less reliable organisations, despite their good experiences with MSF. Besides that the decision about an NGO having a base/office in Pyongyang is not taken by the CRFD [FDRC] but has to be made on a higher level in the government, which takes more time. A period of six months is very long to issue visa for expats. They would consider the possibility of visa for one month each time, which could be extended every month but they cannot guarantee this extension beforehand.

Other points of discussion:

*Budget - The extent of the proposed budget (1,000,000 USD): they asked if there would be a possibility to extend the budget, it’s not big enough. They asked if this was a pilot project and mentioned that other NGOs were offering much bigger amounts. This could be influenced by the current visit of the DHA delegation, which is preparing for a second consolidated UN appeal concerning many millions, which will be launched by the end of June.

*Expats - Number of expats: the CRFD experienced the number of expats in the previous MSF mission, ten in total, as overwhelming. lt has given them a lot of headaches to follow, organise, and control such a big team. This was aggravated by the problems in co-operation with the MSF team in Unpa. They mentioned several times the fact that this team visited Ri-clinics without permission and it was also not laid down in the previous MoU.

*Access to health facilities - Access to the health facilities: if there would be an agreement upon the first point of discussion, the presence of NGO/MSF in the country, there could be further discussion about the extent of access to health facilities. But the first proposal of the CRFD is that there would be one field visit per week, being one or two days, visiting one week Huichon and the other week Pakchon. In general they discussed and ventilated their doubts about the need of expats being in the field. They said that their doctors are well educated and don’t need supervision, control, or whatsoever and that the doctors are not really waiting for that. It is also not necessary for MSF to collect data for surveillance because their surveillance system, as well as nutritional as epidemiological monitoring, is functioning perfectly well and MSF can use the collected data in the capital.

Basically the following answers were given from the side of MSF:

*MSF thinks an office in the country is necessary as to be able to closely monitor the ongoing programme and to go to the field as often as possible to establish a well functioning co-operation with the health workers. For MSF, it is compulsory to have expats present in the country. It cannot be considered at all, to open an office in Beijing. It is possible not to talk about the office but about accommodation but still this should be on a permanent basis. MSF is not willing to start a programme on the basis of infrequent visits from abroad.

Visas could be issued per month but with a programme for six months some kind of guarantee should be given about extension of the visa. What to do if after the first month, when many relief goods have arrived, the visa would not be extended? An intervention of (at least) six months is proposed regarding the alarming nutritional situation of the population, which will deteriorate in the coming months and even continue after the harvest. The harvest is delayed and expected in October. That is five months from the beginning of June, so six months of assistance could be a start to cover this vulnerable period.

*It is explained to the CRFD that within MSF first a programme proposal is made before a budget is fixed. Regarding all the points in a proposal an estimation about the costs is made from which a budget follows and not the other way around. If an extension of the programme would be considered, an extension of the budget would be necessary but in that case MSF wants to know beforehand which population or area to target, so MSF wants to be able to visit health facilities before extension is implemented. MSF doesn’t give ‘blind’ donations. That is what the government of the DPRK would prefer as assistance.

*The mission, for this proposal, would consist of three expats and would of course try to keep to the given rules of the DPRK and not undertake any action, which is not written down in the MoU. It is also guaranteed that MSF as an independent, neutral, humanitarian organisation will not give any information to others (journalists etc.), has no interest in espionage, and is only here to give relief assistance to the population. It is stressed that MSF as an experienced and respected NGO has another and complementary role to play in mobilisation of the international community for food assistance. MSF is in this regard, different than the UN system and has possibilities to lobby on a different level. As there is no [similar] NGO so far in the DPRK. It could be a very good opportunity to mobilise resources if MSF were allowed to have a programme here.

*As MSF wants to implement their programme with and for the population by co-operating on ‘grass roots levels’ it is very important to have unlimited access to the health facilities. One or two days per week is a bit too restricted, but this could be discussed in a later stage and maybe extended as soon as an MSF office is established in the country.

Remarks

*After having been some time in the DPRK, having heard the experiences and anecdotes of other foreigners in the country and having felt the atmosphere, the problems of the government of accepting NGOs in the country seemed quite acceptable. Although there has been a previous mission of MSF, this has given constraints. The other organisations (WFP, UNDP, UNICEF) all operate on capital level and thus are controllable. After the floods of last year many delegations visited the country, and though the government doesn’t always like that, they need to ask assistance, but still within their limits. The door to the country seems to open up a little bit, but we had the impression that it is just a bit too early for NGOs to establish in Pyongyang and to be seen as partners. On the other hand, there is not a definite “No” to MSF and we have to wait for further reactions from the government. If MSF will be invited to come again it is very important that before leaving it is clear what MSF is going to do, where they want to visit, whom they want to talk to and what kind of programme will be implemented. According to the system of the DPRK this should be announced in detail before arriving, otherwise it will not be possible to do anything. We experienced that in this explo mission and that should not be repeated. It is advisable to send a detailed schedule to the government beforehand and to ask for approval.

*It is likely that the nutritional situation will deteriorate fast in the coming months, which is of big concern to the government and the organisations present in the country. The impression exists that maybe adults are very vulnerable because children get food first; they are well looked after by the system and by the family. But still we don’t have any idea about how the children are managing that are not attending in nurseries, an estimated 25%! Malnutrition is not very obvious but it can be understood that the nutritional status of the population is slowly deteriorating and it is just the question how much further this can go? There must be also some micronutrient deficiencies at the moment, but so far nobody has been able to record that, everybody going on field trips had ‘the impression’.

*It has not been achieved to [We did not] meet the Ministry of Public Health in Pyongyang. All the contacts and appointments were arranged by Mr Jong, our counterpart of the CRFD, and it is not possible to take contact with anybody directly. The information we asked Mr Jong to give us about the number of hospitals and the number of hospitalised patients in these hospitals, preferably of the provinces in the north of the country as to decide where food assistance to 8,000 patients could be directed to, has not been given. This in spite of the fact that we asked several times, that it was promised everyday, and that we waited for more than ten days. There have also been no meetings with paediatricians, family doctors, or any other health worker on county level except the director of the city hospital in Huichon. As we had been instructed not to ask for any data, we didn’t obtain information or even get an impression about the current morbidity and mortality figures in health care. As nutrition and infectious diseases are closely linked and as MSF is a medical organisation aiming also at implementing partly a medical assistance programme, it should be made possible the next time to get more information on this subject. [...]

Conclusions

-For the moment no agreement about a MSF assistance programme has been reached with the government of the DPRK.

-The CRFD will discuss the possibility of MSF opening an office in Pyongyang (= a NGO being present in the country on a permanent basis) at a higher level in the government. It could take longer for the government to take such a decision. The results will be submitted to the representative of the DPRK in Paris, Mr Kim and further contacts with MSF will follow in Paris.

-Concerning the contents of the programme proposal nothing has changed so the current MoU could function as basis for further MSF activities.

Recommendations

-To be prepared for a positive reaction from the government and for starting a programme.

-To have an internal MSF discussion with the different sections to reconsider the position of MSF as an NGO in the DPRK and to define the objectives of a possible assistance programme. In other words, to consider if it is the right time for MSF to have another attempt or that maybe it should be delayed, till a more favourable time regarding the political climate in the DPRK.

-For a next visit: to discuss and write down in detail beforehand the programme-schedule of MSF and to insist on approval for this schedule before leaving Europe.

-To revise the MoU when thought necessary and to indicate in more detail, the hospitals where to distribute food besides Huichon and Pakchon. It is needed to obtain the figures about the number of hospitals and the number of hospitalised patients in the different counties (preferably in the north, being the most vulnerable areas after the floods and regarding accessibility).

-To read the WFP report of Lola Nathaniel and to have contact with Trevor Page.

DOCUMENT

Minutes of the Meeting of MSF France Board of Directors, 31 May, 1996 (in French).

Extract:

North Korea (Brigitte Vasset [MSF France, Director of Operations])

Brigitte explained that there are currently two missions that the operations are ‘hanging onto’ whilst the interventions are far from simple and there’s a risk of manipulation: North Korea and Bougainville (the latter will be discussed during a future board meeting).

After extensive flooding in the country, MSF spent three months in Korea, in 3 different parts of the country. Negotiations with the authorities finished with the acceptance of expatriate presence in the field for four nights during the week (such a presence was impossible before). The team reached the conclusion that a nutritional problem had emerged due to economic collapse (drop in exchanges with China and Russia) and the catastrophic effects of flooding on the harvests… The data communicated by the government is impossible to verify and the exploratory mission at the end of April (two persons) did not manage to travel around. Everything takes place in a climate of maximum control and suspicion on the part of the authorities, which did not appreciate the messages circulated by the international press following the floods.

MSF proposes a medical-nutritional intervention in the hospitals. Cost of the operation: 1 Million US$:

-Food in the hospitals for around 1,000 patients (children and adults) by attempting to get up to the states in the north.

-Supply in medicines and training programme on the use of these medicines (pharmacopoeia mainly based on plants found in the country).

Discussion

Does this meet the conditions of an intervention corresponding to MSF’s charter? Frederic pointed out that MSF is dealing with a ‘perfect’ regime in the Orwellian sense. [...]

A complex situation: Martine explained that Korea is a complicated country. There’s real national pride for them. Korean medicine is the best in the world and when we talk to them about malnutrition they deny its existence… Yet for the first time the government is asking for food…

For or against an MSF intervention? A discussion took place between:

-Those who are extremely wary of the regime and think that if MSF is authorised to intervene it can only be for future manipulation (Frederic, Guy, etc.). Esmerelda doesn’t understand why we are starting a programme that already costs 1 million US$ for a trial… Christiane asked what we base our work on, when no one is allowed to carry out a nutritional survey…

-Those who think that there are people behind this regime and it’s worth trying to evaluate the situation despite the risks, without being naïve and by having confidence in operations (Maurice, Odysséas, Jean-Luc, etc.).

On 11 September, 1996, MSF was selected as the laureate of the Seoul Peace Price. MSF aid to North – Korean floods victims is mentioned as one of the reasons of the reward. www.video.1

DOCUMENT

“Médecins sans Frontieres wins Seoul Peace Prize,” Press Release from Seoul Peace Prize Committee, 11 September, 1996 (in English).

Extract:

Médecins sans Frontières (Doctors without Borders), the international volunteer group of doctors, nurses and medical personnel, has been chosen as the recipient of the 3rd Seoul Peace Prize. [...] The Seoul Peace Prize was established following the 1988 Seoul Olympics to commemorate the contribution the Olympiad in Korea made to world peace and to the thawing of the Cold War. The Seoul Olympics broke the cycle of boycotts seen at the 1980 Moscow Olympics and the 1984 Los Angeles Games. [...]

MSF’s recent work has included dispatching medical teams to armed conflicts in Rwanda, Burundi, Afghanistan, Bosnia and Chechnya. It has sent missions to help the victims of natural disasters in Japan, China and North Korea, where, from October to December last year, a team of doctors and support staff from France, Belgium and the Netherlands provided medical assistance following devastating floods.

From 25 February to 8 March, 1997, in answer to a FDRC [CRFD] request for spring barley seeds, and after an earlier assessment mission in January, MSF implemented seed distribution in several North Korean counties. The team was authorised to visit the places where the wagons of seeds, coming from China, were arriving. Again, some members of the MSF France Board of Directors strongly expressed their disagreement with this approach.

DOCUMENT

North Korea Email from Martine Lochin, MSF France Programme manager to MSF Belgium and MSF Holland Programme managers, 22 January, 1997 (in English).

Extract:

Yesterday, the exploratory team came back from North Korea. I hope you received their report. The decision, we took yesterday, is to try to do this programme. It means that MSF will look for donors to finance the program of semences [seeds]. The programme is agricultural... but we think it is a possibility to keep a contact with North Korea... and try again to find a possibility to investigate the medical problems and to be involved in medical programme in the future. The condition is to find a donor before the first of February to be able to begin the programme at the beginning of March. It is very short. What is your opinion?

DOCUMENT

“MSF Project in North Korea,” Email from Olivier Lesrel, MSF France Food Unit, forwarded by Mario Goethals, MSF Belgium Director of Operations to William Claus and William Bourgeois, MSF Belgium Programme manager, 19 February, 1997 (in English).

Extract:

After an appeal of North Korea for double cropping barley seed distribution, an assessment team was sent in January: a French agronomist and a Dutch doctor who worked for MSF in North Korea before. We wrote a proposal after their visit. EuronAid accepted to finance 2,200 tonnes of barley seeds delivered to Pyongyang. They arranged everything for the purchase with a contractor (Chemimex) and a booking agent (Huding). They both left today for China. With our advice, they put a condition, which is that the Chinese supplier delivers the seeds before Feb. 28 at the border. Only what is delivered before this date will be financed ant sent by EuronAid to Pyongyang.

They finance us for the expatriate and other costs, but the big amount of seeds (around 1 million ECU) will be paid directly by them. There is no risk for MSF then, but also no big amount of money included in MSF account! It has been agreed that expatriates will go twice to North Korea:

-The agronomist and I for seed distribution monitoring, coordination and reporting to donor (not much operational work can be done over there). From Feb. 25 to March 8.

-Two expatriates in June for the crop assessment. Three persons if we can negotiate to send a doctor to have a medical assessment on a subject to be agreed.

DOCUMENT

“Barley Seed Distribution to the Democratic People’s Republic of Korea (DPRK),” 25 February - 8 March, 1997 – Report, Olivier Lesrel and Patrick Lesgards MSF France Food Aid Unit (in English).

Extract:

History of the project

In January, Médecins Sans Frontières (MSF) sent an assessment mission to the DPRK in order to analyze the request of the Flood Damage Rehabilitation Committee (FDRC) for spring barley seeds. Double cropping with barley followed by rice or maize is applied in the DPRK from this year on, as one of the measures to rehabilitate the flood damages, and increase the agricultural production. The DPRK requested 14,000 tonnes for 100,000 hectares. The MSF mission came back with a proposal for the distribution of 2,200 tonnes of barley seeds (see proposal dated January 20, 1997), which seemed reasonable according to the fact that huge amounts would be difficult to manage in June, when barley harvest and rice planting have to be done within a week or 10 days. 2,200 tonnes of barley seeds are supposed to be planted on 11,000 hectares. Some DPRK stocks will cover 3,000 hectares more and a UNDP grant some additional 1,000 hectares. The total surface is 15,000 hectares and should enable to produce enough barley seeds (if not eaten), to plant the targeted 100,000 hectares in 1998. In January, only seeds were needed by the DPRK since they planned to repair in time their fertiliser factory, which had been damaged by floods. [...] A Memorandum of Understanding (MoU) was signed between MSF and the FDRC, which give details about the role and the presence of MSF in the DPRK, for the project. [...]

June crop assessment

As planned in the MoU, the same MSF team will visit in June a sample of farms that will have received some MSF/EuronAid seeds. The purpose of this visit will be to assess the crop in the fields, with the appropriate methodology. The date will be just before the harvest, probably between June 10th and 20th. It will be also an occasion to estimate the efficiency and benefits of the programme with Korean agronomists, in order to report to EuronAid. If fertilisers have been given by EuronAid, the mission can also include an audit of the fertiliser distribution.

Medical projects

It has also been dealt [agreed] that the crop assessment mission in June will be accompanied by a MSF medical doctor, in order to discuss and negotiate possible MSF medical programmes for the future. To this end, Dr Kim Jong Ha, Deputy Director, Department of External Affairs, Ministry of Public Health was met on March 7th. No relevant information was collected. About malnutrition, it is supposed to be assessed through MUAC, weight/height index and ...intelligence tests. But there is no result at the moment. The UN agencies have been insisting for months for the realisation of a nutritional survey, without success. According to the ministry, medical needs are only drugs and medical equipment, without expatriates if possible. But he accepts to discuss further in June with the MSF doctor.

General situation in the DPRK

The mission arrived in the context of Mr Hwang’s flight to the South Korea embassy in Beijing, but nothing was mentioned in North Korea. Just before the arrival of the MSF mission, on February 16th, was Kim Jong Il’s birthday in Pyongyang, without great success apparently, since there was not a lot people attending the festivities, and Kim Jong D was not seen, officially because of his father’s mourning (3 years). On Thursday [the] 6th in the evening a UN member observed a huge military convoy coming to the centre of Pyongyang with hundreds of trucks of soldiers. It was said to be training. The MSF expatriates were really welcome, and their stay was facilitated, with half priced rooms in Koryo hotel and a day by day programme as flexible as possible over there. On Sunday, it was possible to walk across Pyongyang alone and all pictures were allowed. […]

The food situation seemed to be described [as] severe, only on the basis of figures given by the DPRK government. No UN representatives seem to have seen real significant signs of food shortages or malnutrition. It seems that only small anecdotes and big hypothesis can be reported. The UNICEF representative says that she can never see more than 10% of the registered children when she visits a nursery or a kindergarten. These children are told [said] to be breastfed or on holidays, but she wonders what is the health status of the children? The fact is that many children can be seen in the villages, outside the nursery. All the children seen seemed healthy.

Roughly speaking, the cereal production in the 80s used to be 7-8 million tonnes. At that time, the DPRK used to export. In 1996, on the same surface, it is 2.5 million tonnes, and the loss due to the floods are only 0.3 million tonnes. The difference could be explained by a decrease of the yield per hectare, which has not been mentioned in any visited farm. In most farms, workers have kept [to] what they used to do before (260 kg/person for one year), even if recommendations had been given to keep less this year. The most common hypothesis is that there is a development of a black market for part of the rice, which is not declared in production figures by the cooperative farms. This rice is said to be partly sold through the Chinese border. The MSF [teams] saw some bags bought in a farm by individuals. The same farm sells excess rice on local marketplaces, only allowed [limited] to vegetables and non-cereal products (these markets take place every ten days in villages or town districts). At the same time there is not enough food for the cattle, part of which is very thin. Lately, one can see some individuals selling food or cigarettes along the roads, or in hidden behind buildings in Pyongyang. It is obvious and official that there is a fuel and energy shortage. Many factories do not work, and it is always explained by the floods. The expatriates who have come in the DPRK for several years (e.g. for subcontracting) mention a permanent deterioration of the situation, including in the quality of work and motivation of the employees. Except for an elite that seem to do well. [...]

DOCUMENT

Minutes of MSF France Board of Directors Meeting, 28 February, 1997 (in French).

Extract:

North Korea

Last year, the North Korean government launched a call for the distribution of seeds in response to a famine. We’ve being trying to follow the situation in North Korea since 1995, when we had a medical presence there. We responded to this call via the food cell, because we thought this was the best way to tackle the problematic of North Korea. An evaluation mission was carried out. We proposed the importation of 2,000 tonnes of seeds, financed by the European Community. 1,200 tonnes arrived at the Sino-Korean border and were transported to Pyongyang and the team is in the process of supervising their distribution at the level of different state farms. A doctor will join the evaluation team in June.

Frederic raised doubts on the appropriateness of this mission. He thinks that the declared famine is fiction. He denounces this mission as assistance to one of world’s biggest dictatorships. He suspects that a large part of aid is diverted by the army. We intervene over there in accordance with rules set down by the dictatorship and we accept these rules and criteria manipulated by the dictatorship and the CIA. It’s a question of principles, how far are we willing to go to work with a regime clearly defined as a dictatorship. If our presence there is symbolic, with a derisory provision of assistance (2,000 tonnes compared to the North Korean government’s latest request of 100,000), we should be working in accordance with our own rules, with the capacity to have a doctor in the team who can see things other than what the regime wants him to see.

Philippe: All the people working on this mission, who have carried out evaluations in the field, and who have helped take operational decisions for its follow up, have other elements to determine their evaluation criteria besides information on the internet or satellite photos manipulated by the CIA. We cannot accuse this team of being in cyber-humanity with our 2,000 tonnes of seeds; we think this is what’s needed right now to ensure a harvest in the future. It’s possible that there’s manipulation. We’ll try and recognise it and evaluate it. Collect concrete information. Be vigilant.

INTERVIEW

In January 1997, that was a brief exploratory mission and nothing came out. They proposed themselves to have an agronomist, to help with the seeds, and MSF proposed that a doctor go too, and see if it is possible to have some kind of a medical programme as well. And that’s why I went; to very carefully find out if maybe there was a way to start something medical as well. During the explo with the Agronomist, Patrick Legard, I asked to see a hospital. We went to the hospital and we were taken to only one room. We were not allowed to see the rest. And in that room, there were three patients, who they said they were on infusions, with beautiful blankets, clean room and they said they were malnourished. I didn’t see any signs of malnutrition. Then, I wanted to go to other rooms but that was not possible, so we had to go outside again. Then I asked to see the operation room. We had to wait about fifteen minutes and then the surgeon came and opened the operation room. And we could see the operation room. When we finished, we went outside and the three patients who had been on infusions passed us on their way out. It was all staged. They wanted to make a good impression, to show you what you wanted to see. You ask to see malnourished children, OK, there are malnourished children. You want to see a room in a hospital? OK, here is a room in a hospital. I think, in North Korea, that’s what they do amongst themselves as well, to the population. It’s all fake. It’s a play, a movie. We don’t really know if everybody believes in it but everybody is supposed to believe in it, so ok.

[...], Physician, MSF Programme in DPRK, September to December 1995, January 1997, June 1997.

INTERVIEW

At the end of 1996, the North Korea Ambassador in Geneva sent a spontaneous request to MSF for the distribution of seeds, saying they were needed post-flooding. Brigitte Vasset, the Director of Operations, asked us to investigate the request with care. We told ourselves that it could be an opportunity to get back into the country, which we hadn’t managed to do via our medical activities. Along with Marie-Pierre Allié and Martine Lochin from the programme managers, we started negotiations in an attempt to respond to their request and set up a programme. We set up an exploratory mission team consisting of an agronomist, and a Dutch doctor who’d been part of the international MSF team in North Korea the previous year. We insisted on having a member of the old team, who’d spent time in Korea. He could be the link between the past and present, spotting changes and developments, seeing if the people were worse off, the authorities tougher, the military more present. We wanted to avoid having to re-start at zero and find ourselves hoodwinked. Obviously the authorities weren’t pleased. They would’ve preferred all new people.

MSF’s evaluation mission arrived in North Korea in January 1997 with the aim of analysing the request made by the Flood Damage Rehabilitation Committee for the distribution of barley seeds.

We organised the purchase of these seeds – Euronaid4 financed us – and transferred them from China to Korea by train. Then the Korean authorities handled the trains from the Chinese border to Pyongyang. Next, we went to see what happened when the trains arrived in the different areas of 14,000 hectares where they were to be planted. They would have preferred us just to hand the seeds over rather than go in person, it was clear. We told them: ‘Out of the question, we need to follow up our operations, know what’s happening, understand what they’re for.’ We understood that they would do the logistics themselves but we told them there would be no European financing if we couldn’t do follow-up in the field, because this was part of the financing conditions. They understood but it was difficult to convince them because they wanted as few foreigners as possible, but also because they didn’t know how we worked. For sure they were locked into their system, but they have skills, structures, organisations. So they were more used to receiving funds from China for carrying out operations themselves than having snoopers like us on their backs.

We had to organise all this quickly, because we had to distribute the seeds before a certain date. This time factor helped us get our visas because we said to them that if they weren’t issued quickly enough, we would arrive too late for the seeds and the programme would no longer have any sense, and so be cancelled. It was really interesting, particularly because it allowed us to go elsewhere than just the big cities. The countryside and villages are completely out of sync with Pyongyang, which is a sort of showcase. Our visit schedule was decided each day, but it was very flexible. It was drawn up according to places or the trains arriving during the night, and it wasn’t always possible to plan it ahead. I think we took up several carriages and we counted the bags. It had been decided to divide up the seeds amongst as many farms as possible because this was a pilot operation. They wanted to see if it worked or not according to the regions, the climate.

We had a driver and an interpreter every time. We had a very specific programme that we managed to change at the last minute on several occasions, arriving in places that weren’t completely prepared for us, so we could see what was really going on. We went to the collective farms. There was a central building, and the people lived in little houses. […] I remember a field, with a choir installed on a slope who sang to motivate the workers who were planting everything by hand. There was no petrol for running the tractors.

On the last day, I went to recuperate the material left by the previous mission in the WFP premises. We didn’t have our interpreter that day; I was alone with the driver whom we’d been with for ten weeks, communicating with him via the intermediary of the interpreter. I was thinking out loud, and I said: ‘We should just put the material in the front.’ Suddenly I heard the voice of the driver exclaiming: ‘In front?’ He spoke French and I suppose he was there to watch over our interpreter!

Olivier Lesrel, Manager of MSF’s Emergency Food Cell (in French).

In April 1997, Chinese businessmen (they always were the main source of independent information on what was going on inside as they were allowed to move more freely than anyone else) and officials from international agencies who visited North Korea noticed that provision of food aid was insufficient, and witnessed heavy signs of starvation among the North Korean people to whom they could have access. At that point, knowledge of this situation had been widespread in South Korea for a while. Meanwhile, a few articles signalling the famine were published in the international press. www.video.2 - 3

DOCUMENT

“Across Yalu River, Children Dying – Traders see North Korea Famine,” Steven Mufson, The Washington Post (USA), 18 April, 1997 (in English).

Extract:

About 200 to 300 trucks a day cross Friendship Bridge over the Yalu River here, hauling sacks of food or other desperately needed goods to North Korea. When the traders and drivers return, they carry tales of starvation, and desperation in the ailing Stalinist nation.

A group of Chinese truck drivers waiting at the foot of the bridge Wednesday reported that they had seen starving children in North Korea. A man who would only give his surname as Re and who was waiting to drive construction supplies to the Chinese Embassy in Pyongyang, the North Korean capital, said that on a recent trip he saw one dead child and two others nearly dead, apparently from hunger, who had been abandoned by the road-side.

“I’ve seen school children staggering like drunkards because they are so hungry,” said a trader named Liu, who has a small Chinese medicine shop nearby and who said he was in North Korea a few days ago. [...]

Gauging the depth of North Korea’s crisis is a critical issue as other countries try do decide whether – and how much – to help a Communist-style dictatorship whose planned economy is falling apart. Disastrous floods there in the last two years have compounded woes that have been mounting since the 1991 breakup of the Soviet Union, North Korea’s longtime patron. International aid experts who have visited North Korea also have reported food shortages and related disease. Last month, Arthur Holcombe, the Beijing-based Head of the UN Development Program, reported seeing cases of rickets and scurvy. But the personal accounts of traders in this Chinese city provide more graphic images of a nation in crises. “Last year it was bad,” said Mr. Liu’s wife. “This year it’s worse.”

DOCUMENT

“Why the World Dithers – As an Epic Famine Sets in, Help is Not on the Way,” Carrol Bogert, Jeffrey Bartholet, Newsweek (USA), 21 April, 1997 (in English).

Extract:

The first thing Catherine Bertini noticed was how small the children were. As head of the United Nations’ World Food Program, she got unusual access to schools and day-care centres on a recent trip to the North Korean countryside. Kids who looked 3 years old turned out to be 6. They moved slowly to conserve energy. Their skin hung slack from emaciated, wrists and ankles. At most schools – unheated and literally freezing - only about 20 percent of them were even present; teachers said the rest were “on field trips.” Where might they really be? At home, perhaps, where the stoves to cook the family’s meagre food left a little warmth lingering in the air? Slowly dying, wherever they were. Most North Koreans are getting only 100 grams of rice per day now; a slow starvation diet, and the government recently confirmed that 134 children died of malnutrition last year. Foreign observers think the number must be higher. U.S. intelligence predicts that 100,000 people will die this summer if help doesn’t come. “Even if you change the system [of socialist agriculture], it’s not going to help people in 1997, or even 1998,” says Bertini. “Is the rest of the world willing to let millions of North Koreans starve to death?”

The rest of the world doesn’t know much about the North Korean famine mostly because it isn’t on CNN. [...] The paranoid government has repeatedly denied visas to NEWSWEEK and other media to cover the disaster. That has made it harder for the World Food Program and other relief organizations to drum up international sympathy for the plight of North Korea. “We need to have journalists who can publicize the situation”, said one relief official. “But that’s like a slap in the face to North Korea.” Pyongyang was struggling to feed its own people even before it was hit by three straight summers of disastrous flooding. Now it faces a whopping grain shortfall of 2.3 million metric tons, though 900,000 metric tons could probably keep people alive until the next harvest in five or six months. But will there be a next harvest? Relief officials fear that hungry North Koreans are too weak to plow and sow and reap - especially since there’s no fuel for the tractors and most of the dray animals have been slaughtered.

What strikes the hunger experts first is how much North Korea differs from a typical African famine. There are no mass migrations of starving refugees hunting for food – North Koreans would lose what tiny rations they get from the government if they left home. There are no markets where people sell their last belongings in order to buy food – private commerce is illegal in North Korea, and selling grain is a crime punishable by death. It’s harder to see how malnourished people have become under the padding of winter clothes than it would be in the hot climates of Africa. But perhaps most unusual, North Korea is an urban, industrial country - a backwater, to be sure, but not a peasant society. And the government remains in full control. “In Africa, the most vulnerable groups in society fall through the safety net first,” Says Michael Ross of the World Food Program. “In North Korea, it’s more like the net is being lowered inch by inch, until it hits rock bottom. That’s just about where North Korea is now.”

Still, many countries are loath to bail out the Pyonggyang regime. After recent charges that North Korean agents kidnapped a young Japanese girl 20 years ago and spirited her away to Pyongyang, Tokyo has delayed sending any food aid. South Korea has committed $6 million to the World Food Program’s emergency effort but wants political concessions from its old enemy before it will do more. “We can negotiate government assistance to the North only if the four-party talks begin,” says Assistant Unification Minister Moon Moo-Hong, referring to the formal peace negotiations that South Korea is eager to get underway. Washington has pledged $10 million, which might buy a paltry 30,000-plus tons of grain and is considering upping its contribution. But Defense Secretary William Cohen, touring the region last week, also linked food aid to the progress of political talks. And Republicans in Congress often berate the Clinton administration for “propping up” North Korea. Humanitarian officials say that’s playing politics with innocent lives. “This should not be about diplomatic posturing,” says Andrex Natsios, vice president of the relief group World Vision and an aid official in the Bush administration. “This is about vulnerable people who have no political power, who are dying. I’m a Republican. But this is just not acceptable.” Still no one denies that the people really playing famine politics are North Korean officials who want to hang on to their Stalinist system. The two greatest famines of the century took place in Ukraine in the 1930s and in China in the early 1960s where the collective system of agriculture ruined the harvest. The world understood the scope of the disaster only afterwards. That, tragically, is just where North Korea is heading.

DOCUMENT

“Aid Agency Sees Malnutrition, Deaths in N. Korea,” Reuters (Beijing) 29 April, 1997 (in English).

Extract:

North Korea is sliding into famine with reports of deaths of children from malnutrition and farmers eating powdered wood to fill out their diet, an official of the international aid agency Caritas said on Tuesday. “The overall situation is just going down,” Kathi Zellweger, director of international cooperation for the Hong Kong branch of Caritas said in an interview after visiting the reclusive Stalinist state. “It’s like a ladder I’m climbing down and I don’t know where the bottom rung is,” she said referring to visits in recent years. A day earlier the United Nations’ food aid agency called for large-scale emergency aid to North Korea to avert a famine that could turn into “one of the biggest humanitarian disasters of our lifetime.” On a visit to areas devastated by unprecedented floods in 1995 and again in 1996 when entire crops were destroyed, Zellweger said she saw fewer children in schools, listless infants and heard of deaths from malnutrition.

The headmistress of a school in one county described the situation as the worst since the Japanese occupation of World War Two, an invasion regarded by Koreans as one of the darkest points in their history, she said. [...] “I feel it’s a famine in slow motion,” she said. “If no major food aid is going in fairly soon it will just go further down and could deteriorate very, very rapidly,” she said. “We can only hope for the best, we have to prepare for the worst.” The U.N. World Food Programme launched a $95.5 million appeal this month for 203,000 tonnes of emergency food for North Korea. The agency said on Monday it had received just one-third of the money and estimated North Korea needed 1.3 million tonnes of additional food to meet its basic needs in 1997. Zellweger said local officials told her they distributed 100-350 grams (3.5 - 12 ounces) of rice per adult per day, although some areas said they had been unable to distribute since mid-March. That compared with the minimum recommended by Caritas of 450 grams (1 lb) per person per day. “Officials say they will run out of food fairly soon... They asked me several times to look at quantity and not at quality of the food aid we bring in,” she said. [...] North Korea has said food supplies will run out at the end of April. The WFP estimated there was only enough food to feed the country until June and then its 24 million people would have to wait for the next harvest in October and November.

DOCUMENT

“North Korea’s Famine is a Product of its System, Not Nature,” Philip Bowring, International Herald Tribune, (Seoul), 3-4 May, 1997 (in English).

Extract:

So how come the world’s most over-governed society, a semi-industrialized economy in a fairly compact country with multiple land and sea access points is starving? The answer is very simple: because of a political system similar to that which brought famine to rich parts of China during Mao’s Great Leap Forward and to the Soviet Union during Stalin’s collectivization campaign. As in those cases, North Korea’s famine has resulted primarily because the political leadership has far more important objectives than feeding its own people.

In the Korean case, the first objective is to keep the country as closed as possible, to prevent citizens’ being able to compare their fates with those of neighbors in China or South Korea.

Secondly, the scant resources that Pyongyang has available have been devoted not to purchasing grain and fuel for civilians but to keeping a million-man army in ammunition, fuel and other resources needed to offer a credible war threat to South and the United States. [...]

The food shortage may be an embarrassment and an indictment of Pyongyang’s feudalism in Leninist clothes. But it also has its uses as a lever, allowing Mr. Kim to move closer to his goal of official U.S. recognition of his regime.

Under the cover of “humanitarian” aid, the United States has its own diplomatic goals, notably to bring Pyongyang into four-party talks – the two Koreas, China and the United States – which might eventually head to a peace treaty. The U.S. objectives are note ignoble or entirely calculating. Humanitarian feelings do count. There is also a genuine concern that limited food aid reduces the danger of the North’s choosing suicidal war as a means of escape from the realities of failure. Pyongyang has usually shown a tendency to ruthless cunning rather than suicide, but a final throw by the military, still imbued with the destiny of achieving reunification by any means, cannot be completely ruled out. On the part of the United States and China there is calculation that some aid will prop up the regime and avoid the regional instability inherent in a North Korean collapse. China has short-term fears of a refugee flood, and longer-term ones that a united, non-Socialist Korea might emerge from the failure of China’s Communist cousins across the Yalu River.

The South, meanwhile, is torn by its own dilemmas: Detestation of the Pyongyang regime is balanced by a desire to help it change, and thereby avoid a collapse that would place huge burdens on the South. Underlying all is a desire to help fellow Koreans, but no idea how to do it.

DOCUMENT

“North Korea: Trail of Political Strength Surrounding Assistance from the South to the North – Famine Seems Imminent,” Pierre Lefèvre, Le Soir (Brussels) 7 May, 1997 (in French).

Extract:

The food situation is getting dangerously bad in North Korea. According to the representative of the International Committee of the Red Cross (ICRC) in Pyongyang, the grain reserves have been exhausted since mid-March and most of the rural population survives by eating grass and roots. Travellers coming from North Korea describe children starving and abandoned by the roadside or farmers too weak to cultivate their land. A humanitarian catastrophe seems imminent.

The United States and South Korea have finally decided to accord substantial aid to Pyongyang, but it continues to depend on a double negotiation of a highly political nature, which has not yet been concluded. [...] In fact, the question seems more complex and more political. The Red Cross of the South has linked its aid to three conditions: that its South Korean origins are identifiable, that it can cross the demilitarised zone which separates the two countries and that agents from the South can go to North Korea to watch over its transportation. South Korea was offended when Pyongyang forbade the slightest indication of where the first deliveries of aid in 1995 had come from. And it wants assurances that the army or political elite will not divert the new supplies.

For Pyongyang, however, this touches on three taboos: recognising that the doctrine of self-sufficiency held so dear by Kim Jong II’s regime has failed; opening the North Korean fortress to foreigners; and showing the world the country’s state of distress following 40 years of a Stalinist regime.

DOCUMENT

“From North Korea, Tales of Desperation,” Seth Faison, The New York Times (USA), 28 April, 1997 (in English).

DOCUMENT

North Korea: “Scenes of Horror in a Starving Country,” Philippe Paqui, La Libre Belgique (Belgium), 29 April, 1997 (in French).

DOCUMENT

“There’s a Real Famine in North Korea – Testimony of One of the Rare Westerners to have Travelled around the Korean Countryside,” collected by Pierre Hazan, Libération (France), 30 April, 1997 (in French).

From 4-26 March, 1997, a team of independent experts appointed by ECHO (among them, Georges Dallemagne, former MSF Belgium Executive Director) made an assessment of the humanitarian situation in North Korea. They managed to implement a nutritional survey on a limited scale and reported a worrying situation, even very serious, in certain areas. In April 1997, MSF programme managers contacted again DPRK officials in Europe, and set up a new plan to return and bring assistance to North Korea. At that time, their main objective was to launch a nutritional and food distribution programme.

DOCUMENT

“North Korea,” Email from William Bourgeois, MSF Belgium Programme manager to Martine Lochin, MSF France Programme manager and Wouter Kok, MSF Holland Programme manager, 7 April, 1997 (in English).

Extract:

Please find hereafter a brief summary of the debriefing I had with George d’Allemagne. In view of the situation in North Korea, we propose:

1. To send a team consisting of Hilde Sleurs (doctor/HoM), Peter Van Caille (log) and a nurse first of May.

Explo mission to see the possibilities of implementing:

- Medical/nutritional program in hospitals/health structures

- Nutritional program in child institutions

And this at the level of provinces.

2. To ensure the international coordination for this mission.

Could you please give some feedback on the proposals? Meeting with Georges 04/04/97. Georges visited NK during three weeks in March 97. It is estimated that the country will have a deficit of around 2 million tons of cereals. Officially, only due to the floods of 95. In fact, the agricultural production has been decreasing steadily since a number of years. This combined with the end of aid from Russia and China explains the current problems. The crisis is not only agricultural; the industry is at a standstill. The agricultural production is declining because:

-Damage by floods

-Decreasing quality of seeds

-Lack of fertilisers

-Poorer ground

-No fuel no tractors no beasts of burden -> manual agriculture.

-System of food distribution. The government leaves to the farmers what they need and take the rest for the rest of population (army probably having priority) -> no incentive for higher production.

Georges could not gather ‘proof’ that the situation is dramatic. The available information is not reliable (only ‘politically correct’ information). But was able to gather some convincing evidence.

I. Data about stocks & imports & data about distributed rations: No stocks, only limited import (barter trade with China, trading wood -> deforestation). Rations decreased to 100 g/person/day.

II. Looking around: Eating of bush food. Football fields used to cultivate. Children running behind trucks to gain few grams of food, people looking for algae in rivers, everybody on the fields, [...]

III. Markets/State shops: State shops are empty. Three times a month markets are authorised. Price of rice is a bit less than mean monthly income. (Economy not really monitored).

IV. Home visiting: Families have no food stocks except for some sweet potatoes + algae (changing of food habits?).

V. MUAC ‘survey’ done at three different locations in 5 crèches and 2 jardins d’enfants [Kindergartens]. Total children 437, sample 142 -> 135 under five (3 kwash). Results: 9% red, 22% yellow, 19% white. Except for methodological bias and the fact that in Wonsan it was a day off, Georges feels that there was no manipulation.

->Results in institutions did not show great variations.

->No official clearance was given to make a survey, officially it was training.

Note: Wosan is a port on the east coast. Port activity stopped, children were from civil servants and officers.

Medical

Production and importation of drugs stopped; only traditional drugs available. Hospitals have, no food, no drugs, and no fuel.

DOCUMENT

“Korea Mission,” Letter from Mario Goethals, Director of Operations, MSF Belgium, to Mr Kim, Chargé D’Affaires of the Permanent Mission of the Democratic Republic of Korea, 30 April 1997 (in French).

Extract:

Your Excellence,

Our medical, non-governmental and international organisation, specialised in public health, is concerned by the difficulties the Korean people are currently undergoing. Médecins Sans Frontières would like to offer its assistance in the domain of primary health care and nutrition.

Which is why we propose sending a Médecins Sans Frontières team to evaluate the possibility of our organisation providing assistance. This experienced team would be composed of:

Serge Depotter, Manager of the Food Security Operations Cell

Hilde Sleurs, doctor

Peter Vanquaille, logistician

I should be grateful if you would facilitate the issue of visas for these persons. Propositions for activities will be submitted to the Korean Authorities at the end of the evaluation mission. We are entirely at your disposition for any further information you may require and would very much like to meet you in Paris soon. We would also like to ask for your guidance on which institutions or persons in Korea we should contact in order to gather information about the current needs in Korea and who we should develop concrete propositions with.

With our very best wishes,

Yours faithfully

DOCUMENT

“North Korea” Email from Martine Lochin, MSF France Deputy Programme Manager to MSF Belgium and MSF Holland Programme Managers, 8 May, 1997 (in English).

Extract:

Meeting with Mr Kom, Delegate Representative of DPRK in UNESCO. [...] Again, the concerns and worrying of MSF about situation in DPRK for nutrition and medical. Many sources say that the situation is deteriorating quickly. Again, the proposition from MSF to help North Korean people. So, now, we want to know if we can have the authorisation to do a new evaluation and start a program as soon as possible after this evaluation. MSF has big support from donors (UE, Norway, etc.). We have a team ready to go, and we think that it should be interesting that the team can visit health structures, kindergartens, schools...

Questions for Mr Kim:

-How many people?

-How long?

-How much for the proposal? [...]

Mr Kim said that 6 months is too long. The people of PYG will refuse. So, we introduced the fact that the action of MSF could be less long depending of the results of the explo mission.

How many people: We said 3 people with somebody who knows DPRK (Marteen Groot who is available only next week) with two other people. These two people are available 2 months. So, able to do the evaluation and start the program. Mr Kim said that the explo will be OK for 3 weeks but the explo will have to leave the country because he does not think that MSF will have the agreement of donors so quick to be able to begin as soon as possible the program. We said that we will inform the donors about the explo to prepare them. We have a big confidence and credibility/our donors etc. and we are used to working in emergencies with the donors. Big confusion because of the fax from Mario: Mr Kim thinks that two evaluation teams of MSF ask to go to DPRK. There are a lot of delegations going in DPRK without positive results. So, the friends of PYG and Mr Kim are upset by so many delegations. So, we explained that it is the same team. It is an international action of MSF with the three sections involved MSF B, H and F, and it is coordinated by Paris, etc.

In April and May 1997, South Korea, the USA, and Japan decided to resume their food aid to North Korea, provoking the restarting of the four- power peace talks. www.video.4 - 5 - 6

DOCUMENT

“A Hungry North Korea Swallows a Bit of Pride,” Nicholas D. Kristof, The New York Times (USA), Tokyo, 29 May, 1997 (in English).

Extract:

With a serious famine spreading in North Korea, one of the central obstacles to getting attention and assistance has been North Korean pride, which is as enormous as the country’s need. Vast numbers of North Korea’s 23 million people may be starving, but the North Korean leadership has been reluctant to accept direct aid from South Korea or to allow journalists to visit hard-hit areas and publicize the suffering. The Government of Kim Jong II, the long time “Dear Leader,” now elevated to “Great Leader,” has feared that direct aid and wrenching news coverage of hungry children would be humiliating for the nation and would allow South Korea to score propaganda points.

But this week, in a sign that greater openness may be in the offing, the two Koreas reached a major agreement that will allow the South to send food aid directly to North Korea and to mark the sacks so that it is clear where the aid is coining from. The agreement also allows aid organizations to send food into the North by new routes and to stipulate what region in North Korea will get the food. “I think this is a major breakthrough,” said Lee Yoon Gu, the co-chairman of a South Korean coalition of organizations trying to send food to the North. “Whether or not it will work out, we’ll have to see. But I’m optimistic.” Some others are more skeptical, and everyone agrees that a good deal will depend on how the accord — reached on Monday in Beijing — is put into effect.

Even with its more flexible attitude in those talks, North Korea still rejected the idea of receiving any aid directly from the South at the border crossing at Pan-munjon. The North was apparently concerned in part that it would be demoralizing for its hungry soldiers to see truckloads of food rolling in from enemy territory. So the 50,600 tons of corn, noodles and other food covered by the agreement will arrive on three rail lines from China and at two seaports — still an improvement from the single rail crossing and sole port now designated by the North to receive such aid. The new arrangement will apparently allow organizations in the South that contribute 1,000 tons of food to designate the town in North Korea that will get the aid. But there will be no on-site monitoring, and in any case it will still be impossible for South Koreans to send food directly to particular people or families.

“The North Koreans are very suspicious of anything from the South,” said Bernard Krisher, an American in Tokyo who recently delivered aid to North Korea. “As desperate as they may be, there is a lot of pride there. They don’t want to look like beggars, and they are suspicious of South Korean motives.” [...] The United States is sending $251 million worth of food to North Korea, and the South Korean Government has also sent a modest amount of allowed aid from the private sector, such as the 50,000 tons agreed to this week. But the South Korean authorities insist that-they can send large-scale assistance only after the North agrees to a proposal for four-party peace talks involving the two Koreas, China and the United States. “The urgent problem is peace on the Korean Peninsula,” said Moon Moo Hong, the assistant minister of unification in South Korea. Mr. Moon said that the fundamental obstacle is North Korea’s truculent attitude, and he added that while North Korea needs $300 million to buy food and avert starvation, it is spending billions of dollars on its military forces each year. Another South Korean official said that this week’s agreement was intended to encourage the North to be more flexible and join the four-party talks, in an attempt to end the state of war that technically still exists on the Korean Peninsula. “We’ve done our part, and now we expect them to be more positive on the four-party talks,” the official said.

Japan’s Government has taken a tougher line on aid than most countries, partly because of recent reports that North Korean spies have kidnapped Japanese over the years and taken them to North Korea. The North has denied the charges. So Chung On, a spokesman for North Korea in Japan, noted that Japan has huge stocks of surplus rice in storage. Some of this rice will rot In the June rains and go to waste, when it could be used to help hungry Koreans, Mr. So said.

In June 1997, the MSF France emergency food unit returned to monitor the crops resulting from the seed distribution implemented in February, and to negotiate a medical programme with the medical authorities. They came across a MSF Holland exploratory team sent at the same time to North Korea. The result was authorisation for MSF to set up a one month-long programme to provide medical material to three hospitals. Then, a proposal for another six month-long programme was negotiated. The North Korean officials made it clear that they were more interested in huge quantities of aid rather than in the quality, and were reluctant to have MSF expatriates present in several counties. Eventually, on 3 July, 1997, MSF and the FDRC signed a memorandum of understanding valid for one year. They agreed upon the implementation of a ‘medical and nutritional emergency relief programme’, officially starting on 5 July, 1997, in 34 counties of South Pyongyan, North Hwangae and Kangwon provinces. While the first one month-long programme was mainly financed with private funds, the 6 month-long programme was to be completely financed by ECHO.

DOCUMENT

“Proposal DPRK/MSF Medical Emergency Relief Programme, Project Period: 4 June - 4 July, 1997,” MSF, June 1997 (in English).

Extract:

Introduction

The government of the People’s Democratic Republic of Korea (DPRK) requested MSF to field a small exploratory team consisting of a team leader, a medical doctor and a logistics expert. This mission took place from 24 May until 4 June 1997. The main purpose of the MSF explo mission was to re-establish formal contact with the authorities in Pyongyang. If allowed to travel, the mission’s ToR [Terms of Reference] was to assess the medical and the nutritional situation in the DPRK at large and in specific areas of the country. The ToR also allowed the mission to propose an emergency programme to the government if certain conditions were met. The Government’s Flood Damage Rehabilitation Committee kindly allowed the MSF mission to visit 4 counties: Ichon, Unpa, Pakchon and Huichon. On the last day of the explo mission an extra visit was made to the maternity hospital in Pyongyang, the capital city. [...]

Proposed intervention by MSF

It was proposed by the mission to start an immediate medical relief programme, in two phases. The first phase of the programme will last one month, the second phase at least 6 months, or any longer or shorter period to be agreed upon between DPRK and MSF. Whether or not a nutritional component has to be added to the MSF programme in the second phase has not been decided yet. Mainly because insufficient objective data about the nutritional status of the total population and especially the under 5’s could not be retrieved. It’s the opinion of the mission that, based on anecdotal information, the clinical status of children in the various hospitals and clinics that were visited and the overall picture in the streets of the various villages and cities, the DPRK has not reached a famine-like situation. A nutritional component may later be added, in the second phase, as part of a comprehensive MSF programme in the DPRK. All hospitals and clinics that were visited – see the assessment report - reached the zero stock level for at least western-style basic drugs. Patient with acute diseases cannot be treated adequately. Most basic medical materials are also not available anymore.

The mission proposed to start with an immediate targeted distribution of basic medicines and medical materials to selected hospitals and clinics in 4 different counties. Institutions will receive MSF materials based on their knowledge level, drug consumption, prescription behaviour, and whether or not they have been in contact with MSF before. The first month of the project will also be used to fine-tune the relationship with the DPRK and to further assess the medical and nutritional status in the country.

DOCUMENT

Fax message, from Jules Pieters, MSF Holland Emergency Unit, from Bangkok on his trip back from North Korea to MSF Holland Programme manager, 6 June, 1997 (in English).

Extract:

I really think it would be better for MSF to finance the first month out of our own funds. The most important reason is that we agreed this with the government. It’s specifically stated in the MOU. Besides this, humanitarian aid in the DPRK is highly political and donors are trying to influence organisations to lower their standards. IFRC [International Federation of Red Cross] and UNICEF simply state that their aid is ‘political.’ It is important for MSF to be independent, especially the first month of trial and error. Don’t forget that the government is a smart one. If we do not stick to the letter of the MOU that we all agreed to, we give them the opportunity to do the same. The UNESCO delegation in Paris has had contact with ECHO before. Later on I am sure many donors are willing to give generously for the DPRK.

Furthermore:

Keep your fax messages and phone calls to Pyongyang strictly to the point, no jokes and no referrals to money if not really necessary: no budget proposals, no donor correspondence. Also avoid the impression that there might be a difference of opinion on MSF European level (which never happens of course). Never write North Korea as the address. We’re working in Korea or the Democratic People’s Republic of Korea.

For future team members during the second phase:

We are not looking for the MSF emergency rush-rush staff with T-shirt and jeans (slight caricature, sorry). We need experienced, 30+ diplomats with public health experience and/or experience in another field) who are willing to wear shirt and tie if necessary. MSF staff cannot be really operational; we’re in Korea in an advisory role. MSF doctors cannot be involved in direct patient care. This may, of course, change in the future after we’ve built up confidence. Then MSF doctors may very well be involved in direct patient care, based on mutual trust between the colleagues. At the moment the Koreans are extremely sensitive about the point. The word ‘training’ should be avoided for example; it is better to use ‘exchange of information’ between colleagues. It’s better to recruit doctors; nurses are not too high on the social ladder. I know it is a bit complicated and it may sound a bit over the top for you, but it is reality. If MSF wants to stay in Korea we have to play the game. English seems to be better understood than French or any other world language.

DOCUMENT

Letter from Marie-Pierre Allié, MSF France Programme Manager to Werner Scholtz, ECHO, 11 July, 1997 (in English).

Extract:

Dear Sir,

Médecins Sans Frontières is planning to implement in the Democratic Republic of North Korea a medical and nutritional emergency relief programme. A first mission started a one-month project in June. This consisted of targeted distribution of basic medicines and medical materials to selected hospitals and clinics in 4 different counties. During this month, the MSF team in North Korea had the opportunity to meet health officials, and to visit various health structures. Following this first phase, MSF is now able to propose a longer-term project in North Korea for the next 6 months. This project will cover 3 provinces and consist of supplying of drugs and medical materials to the health structures, training on the proper use of essential drugs, improving the nutritional management of the malnourished children and providing drinkable water for some health facilities.

This will be an international MSF mission, with the Belgian, French and Dutch sections involved, each section taking care of one province (MSF F: Kangwon, MSF H: North Hwangae, MSF B: South Pyongyan). The activities will be similar in each province. A team of two expatriates will be present in each province and the coordination team (2 persons) will be based in Pyongyang. Therefore, we would like ECHO to consider three different funds allocation and we would prefer to sign 3 different contracts, one for each section. You will find enclosed the narrative and financial proposal for this intervention. The total project will amount to: ECU 3,875,000. We would very much like to meet you in person to discuss the project in further detail. As you proposed earlier, Thursday [the] 17th is suitable for us, if it is still convenient for you. Thanking you in advance for your attention, we look forward to hearing from you soon.

DOCUMENT

“DPRK” Email from Jules Pieters, MSF Holland Emergency Unit to Marie-Pierre Allié, MSF France Programme Manager, 16 June, 1997 (in English).

Extract:

Salut, Marie-Pierre,

Hilde called me to talk about money matters in Dutch. Too many ears listening. She will call you today as well. Hilde and co. are talking about the second stage of the programme with the committee. The committee in Pyongyang seems to be a bit more reluctant than they were to allow for expats in the provinces for the second stage of the programme. Main question as always is: how much money and programmes can MSF organise? The DPRK is not so much interested in quality, but more in quantity. Hilde and co. have no problem travelling around, that is very positive. Data collection and the willingness if the ministry to make data available remains a slow and touchy process. The apartment for expats is not ready yet, there seems to be a problem with furniture.

We need to hear from ECHO how much money they would like to give to MSF in one go. DPRK wants us to work in 3 entire provinces. IF we prepare a comprehensive approach -(medicines distribution, training, distribution BP5 and high energy milk for example) with 2 expats in each province and two expats in Pyongyang (8 expats), Hilde estimates a total cost of around 8,000,000 USD for 6 months. Personally I am not too happy with the 3 provinces, given the constraints we already have; it would simply overwhelm us. I would prefer to start in one province with 4 expats and then slowly expand. The DPRK is not in favour of this. They also like to have as few expats as possible. The higher authorities seem to have noticed the increased MSF presence now and they do not seem to like it.

DOCUMENT

“Memorandum of Understanding between the Flood Damage Rehabilitation Committee and Médecins Sans Frontières,” Pyongyang, 3 July, 1997 (in English).

Extract:

MEMORANDUM OF UNDERSTANDING BETWEEN:

The Flood Damage Rehabilitation Committee, hereafter called FDRC, represented by the Director for External Affairs, Mr. Jong Yun Hyong and the international private humanitarian organisation Medicines sans Frontières, hereafter called MSF, represented by Emergencies Director, Jules H.M. Pieters.

TAKING INTO CONSIDERATION

-That severe floods in 1995 and 1996 caused considerable agricultural damage and losses of food supply to the population

-That due to consequent food shortages the nutritional status, and herein the health status, of the population of the DPRK becomes seriously threatened

-The mutual positive experience of past and present co-operation between the FDRC and MSF

ACKNOWLEDGE THAT THEY HAVE AGREED THAT

-This MoU is valid for a one year period, commencing 5 July 1997

-MSF can continue with a medical and nutritional relief programme in DPRK commencing 5 July 1997, for the duration of 6 months.

-This programme will be known as “FDRC/MSF Medical and Nutritional Emergency Relief Programme”

-This programme (for details and planning see programme proposal) will be implemented in close co-operation and collaboration with the FDRC, weekly meetings with Ministry of Public Health

-The programme will be jointly evaluated by the partners after 4 months; the results of this evaluation shall be used to facilitate a decision to extend the programme for a new period (third phase)

-Medical and nutritional assistance as described in the project proposal will be limited to the following project area:

South Pyongyan Province: Pyongson city, Kaechon city, Dokchon city

Counties: Unsan, Sukchon, Pyongwon, Mundok, Pukchang, Songchon, Daedong, Zungsan

North Hwanqhae Province: Sariwon city, Songrim city

Counties: Hwangzu, Yontan, Bongsan, Unpa, Rinsan, Sohung, Suan, Yonsan, Koksan, Singye.

Kanqwon Province: Wonsan city, Munchon city

Counties: Chonnae, Anbyon, Kosan, Tongchon, Kosong, Hoiyang, Sepo, Pangyo, Popdong.

Total population: 4,345,000; Total counties: 34 [...] The total estimated cost of the programme is 4.5 million USD, MSF will seek funding for this programme from its (institutional) donors, amongst others, ECHO, USAID, European and other governments and the general public. [...] MSF can field eight experienced MSF expatriate staff for the duration of the project: 1 Head of Mission, 6 (para)-medical staff and 1 logistician;

-The MSF expatriate staff can travel freely and perform their duties in the described programme area, based on a weekly planning to be provided to the authorities. The expats working in North Hwanghae and South Pyongyan Province will be based in Pyongyang but can have regular stays in the province. The expats based in Kangwon will be based in Wonsan. [...]

-A MSF Operational Director can pay a 10-day visit once during the programme period;

-Two medical and/or technical consultants (specialists) can each pay a 10-day visit once during the programme period. The purpose of their visit will be, amongst others, to advice programme staff on the implementation of the current project and the content possible additional projects;

-A financial controller can pay two 5-day visits during the programme period to assist the programme staff with the proper financial administration of the project.

INTERVIEW

I returned in June, with the agronomist and the doctor to see what the seeds had produced, how they’d been used. I was also supposed to try once more, via this programme which had got us back into North Korea, to re-establish contact with the medical authorities and see what we could do in this domain.I’d organised a meeting between Maarten and the Health Minister in advance. But in the meantime we came across another MSF team, who’d come at the same time. Patrick and I withdrew ourselves from the medical issues and we suggested to the other MSF team that it accompany Marteen to the Health Minister meeting. And we carried on with our agricultural business. The other MSF volunteers were put up in a suite in an old hotel, 10 to 15 kms away in the suburbs, on their own. We explained to them that they’d been put in such an isolated spot to avoid contacts with the population. As they hadn’t seen anything of North Korea, everything seemed normal to them, they didn’t question anything. They were so bored that we saw a lot of each other and in the evening they’d tell us what they’d been up to. Each time I asked them if they were aware of what previous MSF teams had experienced. They were focusing on malnutrition issues. I told them to check that the same malnourished children weren’t being produced each time. When they’d got a better handle on the situation, they realised that this was the case. The same malnourished children were used - and they were more ill than malnourished, incidentally - because there was no striking malnutrition at the time.

Olivier Lesrel, Manager of MSF’s Emergency Food Cell (in French).

INTERVIEW

They made it clear that it was only temporary and that they of course could deal with the situation. ‘If you want to help you can!’ It was difficult because they made it clear that ‘you donate your materials and we distribute the materials.’ That’s not the way we work so it took more than two weeks to negotiate access under our conditions. It was a very interesting period because it is an unknown country - it’s closed and sealed off. We were one of the very few westerners that were allowed in. The deal that we made was that MSF could have teams in the three provinces and they had access to anywhere they wanted to go under North Korean supervision of course. I did the negotiations and reported back to Paris. Paris was the one that coordinated between Amsterdam and Brussels and I said: ‘Well, this is the result of the jury - and let’s go - or my advice, let’s try. Once we’re there, you have a good coordinator, a good diplomat, and—you may get better access but this is the best deal we can get at the moment.’ Brussels was very adamant to go because Brussels as always, had a huge ECHO contract in its pocket. And sometimes, I think, money is more important for Brussels than the principle. So I had to find a nice compromise between what Brussels wanted and Paris was very, ‘What about access and can our doctors work with?’ You know, the normal story! And Amsterdam was a bit in between. Under those circumstances, I think I got the best deal. And then I handed it over to the permanent team. In a way, in hindsight, I don’t think that MSF should have intervened because it was not a clear-cut case that there was a large-scale famine going on and MSF could not operate fully under its own conditions. So it was a compromise between MSF and the North Korean government. But, on the other hand, we thought, once we are there we can look around and it’s just a matter of slowly continuing with the negotiations. And then, we may or may not have better access.

Jules Pieters, MSF Holland Emergency Programme Manager (in English).

INTERVIEW

In June, Jules Pieters [MSF Holland Emergency Programme Manager] had done an assessment, and the agreement was that during the month of June or July, MSF would distribute medical kits in the counties where they had been working, and see how things were in these counties. At the time, they would prepare them for new projects, not in these counties but at a provincial level. I think, the kits distribution was more to get a good relationship; it was part of the deal. I went there because I had been there before; they said: ‘You need to go to these counties again and distribute the medical supplies and see how things are.’ It was a bit last moment. Jules Peters went in May and I went in June, after they’d signed the agreement. I did it in one month and then I went back again. I’m not quite sure anymore if they asked me to carry on or if I didn’t have the time. I was also getting a bit fed up with North Korea, I don’t know if I would have signed for another half year in North Korea. It is clear that everybody listens to what you say, there are speakers everywhere in the ceilings, you’re not allowed to walk by yourself, there’s always someone following you, you can’t do anything spontaneously, you’re always restricted with what you would like to do because you always have to bargain, negotiate. It’s very tiring. You really feel locked up and a kind of paranoia starts in your head, which is not healthy.

[…], Physician, MSF Programme in DPRK, September to December 1995, January 1997, June 1997.

From August on, as a drought was now affecting some provinces of North Korea, www.video.7 the food shortage issue was again raised by several relief agencies, and gained increasing coverage by the international media. A deserter officer reported that some people had been executed because they had committed acts of cannibalism. Opinion was divided on the severity of the crisis – and will remain so for a long time. Within MSF, discussions started about a possible communication on the issue of food shortages based on the MSF team experience. On 22 September 1997, the official North Korean agency linked the resumption of peace talks to food aid.

DOCUMENT

“North Korea,” Email from William Claus, MSF Belgium Programme manager to MSF France and MSF Holland Programme managers, 19 August, 1997 (in English).

Extract:

I proposed to the team to think on the fact to do a press release on what we are seeing and what we are doing. There are too many press articles saying how dramatic the situation in the country is without being present. This can be the reality in the mountainous area but certainly not in the area where we are working. We will discuss later on. A’dam proposed 6 trucks to send to NK. I don’t agree with that. We are working already with a huge budget. If we are putting in now extra material we really look like St Nicolas. It can be used for a second negotiation.

DOCUMENT

Fax from Janice Fung, MSF Hong Kong Press Officer to MSF Belgium Programme manager, 21 August, 1997 (in English).

Extract:

Dear William/Jean-Marc,

For your information, I enclose the news clipping about DPRK and the fund-raising appeal launched by Oxfam Hong Kong today. The food shortage problem of DPRK has been a hot issue in Hong Kong. The media talk frequently about the disaster in DPRK. However, there are no concrete figures and the overall picture of the situation is vague. We believe it’s very important to inform the media about our presence and our witness account of the situation whilst we get the consent from the field. Do we have any reports on the figures or research in DPRK. Could you please keep us informed?

DOCUMENT

“Please Help OXFAM Stop the Hunger,” South China Morning Post (Hong Kong), 21 August, 1997 (in English).

Extract:

The 3 boys in the photograph are a few of the 600,000 malnourished children in North Korea. If no food aid comes quickly 2.6 million children are at risk. It’s the worst drought of the century. With no rain for 50 days, most rivers are dry. The government has run out of food supplies. People are forces to eat grass, seaweed and wild plants to survive.

DOCUMENT

“North Korea Sends Troops to Farm Fields,” Susanne M. Schafer, South China Morning Post (China), 3 September, 1997 (in English).

Extract:

WASHINGTON (AP) - Teetering on the edge of famine, North Korea has sent troops into farm fields to bring in the harvest for the military, a senior U.S. officer said Wednesday. The operation has resulted in more food but at the cost of cutting summer training in half, North Korean leader Kim Jong II clearly has ordered that more food be given the nation’s million-man military, said the senior officer, who is based in South Korea and focuses on its defense. “A lot of effort is being focused on trying to get a crop in,” said the officer, who spoke with reporters on condition of anonymity.

The United States, China, and other countries have donated thousands of tons of food to North Korea, where inefficient farm policies, flooding and drought have led to three years of disastrous crops. The upcoming harvest is expected to be very small because of a severe drought this summer. Aid agencies have expressed concern that donated food may sometimes be diverted to the military or elsewhere and have urged the Koreans to allow expanded monitoring to make sure that is not the case. [...] North Korea’s military has its own collective farms and has been so busy working in the fields that training for both air and ground forces has fallen off, the officer said. [...] Despite the difficulties afflicting the nation, the senior officer said he has seen no lessening of discipline among the troops, nor a fracturing of its political and military leadership.

And Mark Kirk, chief counsel for the House Committee on International Relations, said he agreed after being granted what he called “wide access” inside North Korea last month during a visit by a panel delegation. “The military personnel looked in very good condition,” Kirk said. Despite hearing some reports of dissension among the military before entering the country, “we saw none of that.” Committee chairman Rep. Benjamin Gilman, R-N.Y., asked his staff to study just how U.S. and other foreign food assistance to North Korea was being used. China, which provides the majority of North Korea’s food aid, is unconcerned” about monitoring just where it goes, and expatriate North Koreans in Japan believe most of that aid is given to government and military officials, Kirk said. Kirk said he would describe North Korea as suffering a “severe food shortage,” rather than a famine. North Korean officials are dispensing food according to their own determination of need and whether there is any potential for future agricultural growth. Therefore, areas around the capital of Pyongyang are farming better than the less fertile northeastern provinces, he said. “It is clear that international food assistance had made a difference, and where it has not reached, the condition of the people is worse,” he said.

DOCUMENT

“Famine Refugees Drowning,” South China Morning Post/Agencies in Washington, 3 September, 1997 (in English).

Extract:

Starving North Koreans, too weak to ford an icy river into China, have been drowning by the dozen as they try to flee their country in search of food, a South Korean monk just back from the area said. The famine is nearing a peak, with tens of thousands dead of starvation and child malnutrition threatening to stunt the next generation, says a former US disaster assistance chief now heading a non-government relief coalition. Pum Nyun, a Buddhist monk calling for more food aid for North Korea, said he saw 11 bodies floating in the Tumen River in June. “In Summer, North Koreans try to cross [into China] but the water is so cold that they don’t have the strength,” he said through an interpreter. “They fall and they cannot get up. Chinese people say they found 100 bodies in June alone.” Pum Nyun also quoted a Chinese official whom he refused to name as saying in June that 2.8 million North Koreans – more than 10 per cent of the population – had died of hunger and hunger-related illnesses.

North Korea has relied on international aid to feed its 22 million people for the last three years. The monk, in Washington for a conference of aid organisations on the North Korean famine, said he had visited the Chinese-North Korean border area five times this year and interviewed roughly 35 North Koreans. Andrew Natsios, a vice-president of the World Vision relief group, said the famine “is upon us, even though the graphic pictures aren’t there because of reluctance on the part of the [North Korean] Government to admit how bad things are.” He said the peak of the famine could come in 30-60 days. A report that “120,000 people starved to death last year is I think accurate, and I think several times that are dying now,” he said, citing surveys by the UN World Food Programme as well as World Vision. “The grave danger is next year,” he added, saying there was signs the coming harvest “will be a disaster – worse than last year’s harvest which led to famine this year.”

DOCUMENT

Mémo from MSF Holland, 16 September, 1997 (in English).

Extract:

World Vision claims 1 million North Koreans died from hunger. Dead bodies are said to be left in the streets, coffins need to be re-used. They call the international community to stop pretending there is ‘just a food shortage’ and start big relief aid. Call to William Claus, desk MSF B. Sounds worried about this message. It is one in a long row (before Oxfam, ICRC, and the Vatican already sent out alarming statements). The problem is that all aid organisations only cover 15% of the country, and not the mountainous Northern area. World Vision is not on the ground, believes William. So how do they come [up with] these stories? William feels it can’t be true: we should have seen and heard something more. We are also in China, where before the most stories were heard from truck drivers. Nothing shows that the need is indeed that big. But, we also cannot say it is not true, because we don’t have the information. William had been discussing already with communications what to do. He is going to NK soon. I suggested that a press-officer goes with him in order to research the possibilities for communication on this issue and come up with a communication plan. He would consider this. I will contact comms in MSF B about this idea.

DOCUMENT

Article from The Associated Press (USA), New York, 28 September,1997 (in English).

Extract:

A CBS crew that flew into North Korea on a privately sponsored relief flight documented widespread human devastation from famine, including dead bodies lying along railroad tracks and an orphanage filled with emaciated babies. The crew entered North Korea with the organization Americares on what the network described as the first civilian flight from U.S. soil allowed into the country since the end of the Korean War, CBS said Sunday. The footage also shows stunted corn fields, abandoned rice paddies and lines of people waiting for relief which turned out to be nothing more than herbal tea leaves. The report by Peter Van Sant will be shown on the premier episode of “Public Eye with Bryant Gumbel” Wednesday. Van Sant reports that babies, orphaned because their parents were either dead from starvation or too weak to care for them, are so malnourished they are battling life-threatening infections.

The secretive country is generally off-limits to Westerners. In August, CNN aired footage from North Korea taken by its president of international networks, Eason Jordan, who flew in on a commercial flight from Beijing with the permission of North Korean authorities. Using a small digital video camera, he reported on the status of the drought there. CNN also recently had a crew providing pool coverage of the opening of a nuclear plant in the country. International aid organizations say 5 million North Koreans – nearly a fifth of the population – will die of starvation without outside aid after three years of devastating harvests.

DOCUMENT

“Million Dead in Korea Famine,” Jasper Becker in Yanji on the China-North Korea border, South China Morning Post (China), 30 September, 1997 (in English).

Extract:

At least a million people have starved to death in famine-hit North Korea, according to refugees who have fled to China. “This is the figure I’ve seen reported in Communist Party documents,” said a 25-year-old student whose parents are senior figures in North Korea’s Workers’ Party. The massive death tool – about the same as the 1984-85 Ethiopian famine – has been dismissed by South Korea and some Western aid experts. But North Koreans from various provinces, interviewed on the Chinese border, said a death rate of one in 20 of the population was believable from what they had witnessed. “People are dying every day, especially the young and the old. You hardly see anyone over 50, or children under seven,” said a peasant who escaped with this family this month. “In my village some people are crazed with hunger.” A Chinese businessman who regularly travels through North Korea said he saw a lot of people with faces swollen with oedema. “Officials know people are dying, but don’t care,” he said. They had told him that in the eastern port of Hamhung about 30,000 out of a population of 500,000 had died.

According to North Korea’s leader, Kim Jong II said that if just 30 per cent of the population survived the famine it would be enough to rebuild the country and achieve “victory.” “In political study sessions we were told that he is prepared to let 70 per cent of the population die – that is why I fled,” a former teach said. She said that in her city, party members and soldiers were given food but everyone else had to fend for themselves. This year, the Government ordered North Koreans to have more children. Doctors are forbidden to perform abortions and all forms of contraceptives have been withdrawn. “They are trying to stem the population decline,” the student explained. “But people don’t want to have children when they cannot even feed themselves.”

In 1995, North Korea was estimated to have a population of 23 million. The death toll is expected to rise steeply this winter because this autumn’s harvest is the lowest-ever. Those interviewed predicted that tens of thousands would try to flee to China. “It will be their only hope. But the Army had already tightened border security,” one refugee, a former soldier, said. Western experts differ about the death rate. Most say North Korea has staved off large-scale deaths with the help of 800,000 tonnes of food aid grain. “Of course people have died. The North Koreans admit this. But the aid is reaching the most vulnerable,” said Kathi Zellweger, director of the Hong Kong office of Catholic agency Caritas. But Andrew Natsios, of US aid group World Vision, said a survey of North Koreans in China suggested that anywhere from 500,000 to three million people could have died.

DOCUMENT

“The Famine Behind Closed Doors” Romain Franklin, Libération (France), 7 October, 1997 (in French).

Extract:

The biscuits are square, some brown, others green. They’re food substitutes that North Korea produces en mass in the factories outside the capital Pyongyang to offset the famine raging for 3 years in a country living behind closed doors under the dictatorship of Kim Jong II, heir to the world’s first communist dynasty. “The first biscuits are made with tree bark, the second with leaves. They fill up the stomach, but obviously have zero nutritional value. In addition, they’re very difficult to digest, and numerous inhabitants suffer from internal haemorrhages,” relates Catherine Bertini, Director of the World Food Programme (WFP) whom I met last Friday in Paris. The North Korean authorities have also been reduced to gathering algae on the side as food substitutes: “But at least algae has a certain nutritional value” added the WFP director.

Passing through Paris to convince the French government to provide food aid to this country, Catherine Bertini fears the situation will deteriorate. “All food is distributed centrally by the government, even in the countryside. The rations last one month. But now the government has nothing left to distribute and the famine is really serious. With winter approaching, people who are already short of food are going to have less and less.” She estimates that the food shortage, at the end of the harvest in progress, will stand at 2.3 million tonnes of cereals, which represents around a third of the North Korean production. [...]

External help. Previously dependent on grants provided by the socialist bloc and bartering with eastern countries before the collapse of the Berlin wall, Pyongyang has had to accept calling for external help since 1995. But North Korea, one of the most repressive and secret regimes in the world, seems only willing to reveal the absolute minimum required of the famine in order to attract international aid. Despite a presence in the field, it was impossible for the WFP to form an exact idea of the catastrophe. The organisation has received no countrywide government statistics on the famine. A nutritional study carried out by the WFP concluded that of the 4,200 children examined, 17% were suffering from malnutrition: a very low percentage, and so difficult to believe. Even more so because the WFP is not allowed to examine the subjects presented to it and was refused permission to carry out an up to date survey. “Which is why it is impossible to extrapolate,” concludes the WFP director. “The only thing we can be sure of is that the food deficit is serious.”

No way of checking the figures.

In March, North Korean officers stated that barely more than a hundred children had died from the consequences of famine. This figure is highly unlikely. Elsewhere, some extreme hypotheses are being put forward. Last Tuesday the South China Morning Post, one of the better-informed journals in the region, cited North Korean refugees as saying that at least one million citizens had died of hunger. The next day, a recently defected officer declared that several people had been executed for resorting to acts of cannibalism. World Vision, an American NGO, which has provided 1,680 tons of food to North Korea since 1996, estimated in September that the famine was responsible for one or even two million deaths in this country of 23 million inhabitants. Such mortality (5%) is not impossible in the light of comparable precedents: the Chinese famine of 1959-1961 led to 30 million deaths – unbeknown to the entire world, including the numerous delegations who visited the country during these ‘three black years’. Scenes of cannibalism were staged in several Chinese provinces. Later, the Chinese authorities, rather than blaming the crazy Maoist policies, held “natural disasters” responsible.

Hazards of nature.

North Korea, held sway to the personality cult of Kim Sung (deceased) and his son and successor Kim Jong-II, also attributes the current economic wreckage to the hazards of nature, which the director of the WFP denies. For her, only .3 million tons of the deficit of 2.3 million tons of cereals (equivalent to the entire maize production in 1994) can be attributed to the successive floods and droughts that have battered the country over the last three years. The fact that North Korea is perceived as a state with little respect for human rights, potentially aggressive towards its southern Korean neighbour, and possibly in possession of a nuclear arm, does not facilitate the WFP’s task. But nonetheless, it hopes to gather sufficient international contributions to follow through with its aid programme. A new fund raising appeal will take place in November.

From October 1997 onwards, MSF Belgium, the section in charge of backing up the programme carried out negotiations with DPRK authorities about a possible extension in more counties, with more expatriates. MSF France and MSF Holland programme managers were not convinced by the value of this extension. In the meantime, more and more journalists were questioning the humanitarian situation in North Korea. www.video.8 Thus there were also discussions within the operational and the communication departments about the relevance of a communication gesture on North Korea and its possible content. MSF subsequently obtained authorization for an exploratory mission in a northern province, and on 24 November, 1997 was granted further authority by the FDRC officials to implement the next phase of its operations, adding an extra province and expanding to work in 59 counties, with 12 expatriates.

DOCUMENT

Report “Intersection programme managers Meeting on North Korea,” 22 October, 1997 (in English).

Extract:

The principle of an explo mission in the Changang province has been accepted. It will be done as soon as possible by Jacques Tremblay (HoM) and Dominique Lafontaine (Med). [...]

Extension of the present program

-Debate on the fulfilment of the objectives of the present program: increasing of the access of the population to the medical structure, improvement of the nutritional status of the population, gathering of information on the health state of the population. William expresses that it is impossible to make today a good balance [evaluation] on that as some of the expatriates are only newly arrived on the ground and so the programs have a great delay.

-The question of an extension was raised as different options were proposed following the visits of William:

*An extension of six months of the present program was accepted. Concerning the financing, ECHO had shown its interest to support it. Each section has to decide its’ own source of funding.

*The proposition of the local authorities for a geographical extension to the counties not yet covered by the present program in the 3 provinces where we are working now has been accepted. Negotiations have to be done to have more human resources to fulfil our engagement (2 expats more per province).

*On the extension of a fourth province (Chagang):

MSF F is against the idea. First the objectives of the first program must be fulfilled.

MSF H is against it except if there are enormous emergency needs.

MSF B has nothing against the idea and will decide according to the results of the explo mission.

*Assessment mission by a surgeon and an anaesthetist (see William’s report). MSF F and MSF H ask two days of delay before to take a decision.

6. Communication (Maarten absent):

The proposition was made to take the advantage of the explo mission in the North to make [give] information to the media on what we do and what we see in NK.

DOCUMENT

“The Objectives of the Mission,” Email from William Claus, MSF Belgium programme manager to MSF France and MSF Holland programme managers, 30 October, 1997 (in English).

Extract:

Thanks for your new objectives. As I said in the reunion [meeting] I don’t like to review our initial objectives now. I prefer to wait till we have more data and a stable team on the ground. Since one month, we are fully operational with the three sections. Unnecessary to repeat why and surprise!! In one of the provinces (South Pyongyan) 3 TFCs are really working now (3 months in the field) and they are progressing day by day. At the end of the month, we will then have data (Nice that we are talking already of an exit strategy or a handing over strategy??). Secondly I have no problem of making volume in DPRK. It enters in my objectives, which are not the same as yours, but as we are working in a modular system it doesn’t matter. As you say I am certainly ready to discuss but I want to avoid that our discussion affect the operationality in the field. Looking also forward to have your feedback.

DOCUMENT

“Objectives for Korea,” Email from Wouter Kok, MSF Holland programme manager to William Claus, MSF Belgium programme manager, November 4, 1997 (in English).

Extract:

Dear William,

For formality’s sake, I’ll like to put in writing our conversation of yesterday:

-We agree that we would stop the discussion on the objectives for MSF in DPRK until early next year.

-We think that to be a more relevant time because the renewal - or not - of the MOU will be then become an issue.

-It will have allowed the present programs to develop completely, and thus will allow evaluation. This evaluation is relevant for the discussion on the objectives/review.

-We decide this now on the agreement that till early next year, no extension of activities will take place.

-This as reaction on refusal of authorities for the proposed extension of staff.

The activity level will be stabilised on present set of activities.

DOCUMENT

“North Korea,” Fax from Alain Guilloux, to MSF programme managers and communication directors, 20 October, 1997 (in English).

Extract:

We find ourselves under increasing pressure to speak about North Korea here in Hong Kong. But is MSF willing to go public on North Korea at this stage?

1. Agencies in HK usually have, privately at least as many question marks as we do, at the same time they launched in August a high-profile joint appeal. People in HK do care. This appeal met a huge response, the largest in HK for a “non-China” emergency since Goma 94. Oxfam HK raised 1.9M HK$ from the public (245,000 US$) and 3 M HK$ (387,000 US$) from the Disaster Relief Fund from the Hong Kong government. Whereas Oxfam UK (according to Oxfam HK) barely broke even on a similar appeal. Anne-Marie, do you know anything about this? William, following our HK – Beijing telephone conversation of October 15th, I am faxing herewith the Oxfam HK press release where they quoted a ministry of public health official on malnutrition. Could you lay your hands on the AFP wire attribution this figure to Oxfam?

DOCUMENT

“Communication on North Korea,” Email exchange between Ruud Huurman, Press Officer, MSF Holland and William Claus, programme manager MSF Belgium, 3 November, 1997 (in English).

Extract:

My dear Ruud,

-I hope you followed the press articles that appeared in the international press stating that their was a huge malnutrition including cannibalism and other sources of eating. This information came especially from Caritas and other related confessional organisations. I am surprised that there is no report available on what Caritas saw (which is the reason why we didn’t know it) and again it is based on personal thinking and analysis (difficult to do an assessment by helico on malnutrition; at least I am not able to do it but with the help of god you never know isn’t it?).

-So the information is not reliable.

-To avoid to many actors in the game, Alain is informed as the other DO’s.

-We have no authorisation to have more expats on the ground (see with Wouter Kok) it can be the subject of a communication but my dear friend Peter will keep you informed about it.

-If we communicate it will be based on our own experiences and personally I’d try to avoid the collaboration with Caritas on it. Thanks for your questions, and I certainly understand your concern.

WC

From Ruud Huurman:

May I underline again that we should be very aware of the communication part of the North Korea intervention. We had several waves of media attention: what is going on, what are we doing, how bad is it really? [...] Responding to media required good balancing, since some agencies (World Vision, UN-bodies) have been reporting on disastrous famine, where we didn’t really have very substantial information and only from the South. Personally I wasn’t aware that other NGO’s (Caritas-see notes Alain) had travelled quite a lot through the country. We have based ourselves on info from the 3 provinces where we are working. It was from the beginning, stated that reports on severe famine couldn’t be substantiated by anyone, because simply so one had access. I was always told that other agencies have no people on the ground. The North was presented as a complete black box. This is contradicting the above-mentioned visits. May I suggest again that we share the information carefully and that we follow closely on the communications side? If we and other agencies have substantial evidence that the picture that other agencies are suggesting is false, we should take our responsibility and find ways to correct the picture.

DOCUMENT

“DPRK,” Email from Pierre Salignon, MSF France programme manager to MSF Belgium, MSF France and programme managers Holland programme managers and directors of operation, 5 November, 1997 (in English).

Extract:

I agree on the decision that till early next year (when?), no extension of activities will take place.

*But in fact, yesterday, you decided to use the reserve of ECHO budget for the purchase of blankets and bed sheets for hospital(s) in the provinces in which we are working. Why not? It’s difficult for me do have a clear picture of the situation. So I trust you and the teams if they agreed with this proposal (?). But it’s an extension of activities. On this specific issue, I will give you the position of Paris tomorrow.

*On the other hand, William is open if it’s possible to send an assessment in the north. We have to be clear that if it’s the case and if we have clearance to do so, we will have to agree on the objectives of this mission and to be careful not to start new activities if needed before speaking together. I understand that if we accept to go there, we will have to start activities anyway. For me it’s a problem. I agree it’s important to assess the area regarding the food situation. At the same time, I’m worried we continue to extend MSF activities in North Korea without being able to control anything, like ‘puppets’ in the hands of the authorities.

-Regarding communication, we feel here it’s more and more needed for MSF to have a public position, about the food issue. In the provinces in which we have a presence, we have no proof about malnutrition. If I’m right, MSF B opened around 10 TFC = 150 children (Do you have more data?) without seeing a big problem about the so-called ‘famine’. Do you think it’s relevant for MSF to start to say that in the areas in which we have access, it’s impossible to confirm WFP/UNICEF and co statements? I think it is. The problem: We don’t get information from the North except messages from Alain Guillou. In fact, if we go in the north and the situation is under control, it will be difficult not to speak out, even if there is a risk to be pulled out from the country. What do you think?

DOCUMENT

“DPRK? Continued,” Email from Wouter Kok, MSF Holland Emergency programme manager to MSF Belgium, MSF France and MSF Holland programme managers and directors of operations, 6 November, 1997 (in English).

Extract:

Communications:

We all agreed in Brussels that it is about time to take a position towards this “famine.” Also to protect ourselves against accusations of exploitation of the issues for institutional reasons. The comms departments are working on a strategy. I hope. Can you confirm this William?

DOCUMENT

“DPRK-Last FDRC Proposal,” Email from Pierre Salignon, MSF France programme manager to MSF Belgium, MSF France and MSF Holland programme managers and directors of operations, and MSF Hong Kong executive director, 18 November, 1997 (in English).

Extract:

Secondly, I saw the last FDRC proposal. I am not surprised. But I have some questions: With this new proposal, which begins in February 98, MSF would increase its activities in North Korea. 59 counties (35, before). 13 expats (8 before). I have problems to understand what is our strategy? I understand the request from the Pyongyang team to receive support for administrative/log work (the distribution prog and the administrative tasks are important), and to increase the number of expats in the field (supervision would be easier...(?). At the same time, I don’t understand the project to expand our activities in Pyongyang (centre of the country - 9 counties) and in north Hamgyong. Will it be possible, before deciding to extend, to assess the situation? What are our objectives? Do we have information about Pyongyang specifically? I understand also our desire to assess the situation in North Hamgyong (cf. info about so called famine), but I’m afraid we will be pushed to start an important distribution programme without choice.

I know the national authorities are negotiating hard with us: “You give me this (money, material), I give you this (the right to continue).” But I have the feeling that we are manipulated without being able to control the extension of our programmes. Sure there are structural problems in DPRK. But we can’t forget that when we decided to start working there, our first objective was to collect data about the so-called famine. At the same time, more and more NGOs are arriving now in DPRK. So do you feel really we must continue to extend our activities? And if your answer is Yes, why?

I would like also to know the duration of the FDRC last proposition (6 months?) and if the authorities asked us for a specific amount of money to put in this extension? Do we have an idea of the cost of this extension? You can see with my reaction, it’s difficult for me to take a decision currently. I see the process going on and would like to know if we could meet to speak of our objectives in DPRK after February 98. Do we have time before giving an answer to the Korean authorities? I don’t see how to give an answer in the coming days. Sorry, not to be able to give you a definitive position. May be with your answers to my questions, it would be easier... I feel also a meeting with Jacques Tremblay in December is important. William and Wouter, please feel free to tell clearly what you think. Concerning communication, could you tell me what is your strategy as you agree with my position to start speaking out on what our teams see?

DOCUMENT

“Communication on North Korea,” Email exchange between Peter Thesin, MSF Belgium Press Officer and Pierre Salignon, MSF France programme manager, 19 and 21 November, 1997 (in English).

Extract:

From Peter Thesin, Dear colleagues,

Last Monday (17/11) we received the first nutritional report on the situation in 4 counties in the province of South Pyongan. Moreover, we received the authorisation for an explo-mission to the northern part of the country. This mission will leave at the end of November and will be accompanied by our Executive Director Eric Goemaere.

Communication strategy:

1. Week of 24/11: we send a press release based on the nutritional report to the media and at the same time we announce the departure of the explo mission.

2. Week of 08/12: press conference with Eric Goemaere, just back from the exploratory mission.

From Pierre Salignon:

How are you today? I received this message from your comms department yesterday and would like to know why we want to do a press release next Monday. In fact I don’t understand the strategy. I agree on the need to speak out. It’s not the problem. But why do we want to announce the visit in the north, and what kind of info do we want to use (sure we received news from the field, but it’s difficult to do a press release with them). On the other hand, is it really needed to do a press release, and why not to wait the return of Eric from his visit to decide what to do, what to say, the way to say it? We need to speak but maybe with specific journalists only, knowing the situation, which already wrote articles. I don’t know. We need to discuss this matter also. May be next week... Sincerely Pierre

DOCUMENT

“Next Phase of MSF Operation in DPRK,” Letter from Jong Yun Hyong, Director External Affairs, Flood Damage Rehabilitation Committee, Democratic People’s Republic of Korea, 24 November, 1997 (in English).

Extract:

Dear Sir,

I am pleased to inform you of our position on the target areas for the next phase of your operation and the number of MSF expatriates needed for implementing the programme, as discussed in our conversation on Nov. 22. As regards our discussion on the possibility of the next phase of your operation in 68 counties, including Pyongyang suburbs, I have consulted the proposed number of 13 MSF expatriates with the authorities concerned, but the latter allowed only 12 persons for some reasons. Such being the case, I am obliged to advise you of implementing the next phase of your operation in 59 counties except Pyongyang suburbs with 12 MSF expatriates you proposed in your letter of Nov. 12.

DOCUMENT

“End Mission Report,” Payam Fazel, MSF Physician in Kangwon Province, North Korea from August to November 1997,25 November, 1997 (in English).

Extract:

This is a brief review of the activities carried out by MSF in general and MSF France in particular in DPRK which is followed by the evaluation of the undersigned of the MSF function and his recommendations for the future. [...]

3) Malnutrition Management: There are several questions in the minds of people about this interesting issue. The response of the author is the fruit of his stay in the field; several visits paid to the hospitals and discussion with food experts, and different embassy staff members who had stayed in the country for longer time.

I don’t have solid proof for what I claim but I feel strongly in favour of the followings:

Is there a natural disaster occurring in DPRK, with the famine and malnutrition catastrophe as the result? NO, the yield has been theoretically much less than optimal but not to the degree you can call it a natural disaster or famine. Is there a malnutrition catastrophe in DPRK? YES, there was a malnutrition catastrophe in Kangwon Province. This is evidenced by the occupation of more than half of the paediatric beds of the county hospitals by seriously malnourished cases in different visits my colleague and I paid in the same Province. More than 50% of cases were, categorised as Kwashiorkor (Fiona’s report). There is a profound discrimination in the distribution of food between people who are actively serving the government and those from low a socioeconomic level who are not of primary importance for the government. As the authorities explicitly claim, the military is their absolute priority.

I credibly believe they store the new food provided but not well monitored by the food aid organisations, and they consume the replenished old food they have in their buffer stock. I have been credibly told that the situation is much worse in the 6 counties in Kangwon that we are not allowed to visit. We have been negotiating on the inauguration of a TFC at the border of these counties to receive referred cases of serious malnutrition. I recommend this to be followed. [...] I believe our representation is very weak in a ceremony-based country like DPRK. The HOM in particular has hidden himself indoors most the time. We have got a diplomatic/game like relationship that further complicates the situation. This is the main reason Koreans are playing a dominant game of bureaucracy with us. In DPRK, we should NOT be diplomatic!!! We should just be polite, patient but very straight-forward. Otherwise, they are much better than us in games and role-playing.

Expat Paranoia

All expatriates are paranoid about the DPRK intelligence system, and their microphones, jails, etc. Please tell expatriates that DPRK is the safest country in the world for an expat IF you are neither spying nor insulting Kim II Sung. Everybody is worried about his shadows, drivers, translators, waitresses...cool down nothing is really threatening us.

Approach toward Authorities

As a result of the same paranoia most expats have a very naive approach toward Koreans. We should not forget that dictators speak two languages: passive and aggressive and they do it equally well. We should not be naive in our everyday rights and as we are their first experiences, we should open our space as much as possible. This is quite possible I did this and it worked well. Peter was very straight-forward and tough at the same time and I believe he was successful in his relationship with them.

MSF International

It is a mess!! We are far from this dream. It is costly, interfering, and chaotic. We should first agree on our plans, policies, financial system, and then we should mix. One desk decides, two desks nag and threaten to divorce, visitors from three desks to the field, each one will give some noble ideas; poor expats are confused to which groom do they belong!! A lot of money spent for what?? To be honest the only thing the sections have in common in our name: MSF!!!!!

Recommendations

I mention briefly and straight:

1) I believe it is extremely inadvertent to expand either horizontally or vertically more than this. If anybody wishes to expand more he should nominate himself to be the Minister of Health in the next cabinet of Kim Jung II. In the time that most NGOs are taking the responsibility of few counties, MSF has spread its wings over three Provinces and extending his leg nosily to the fourth province to dig. The excuse to explore in the Northern province is to see what is going on inside!! We should make up our mind are we MSF or Intelligence Service?! ACF and CZESVI are arriving along with some other NGOs; let’s give way to somebody else to be blessed by Jesus Christ by humanitarian work!! Americans are begging for some room in DPRK let them take over and open the way for McDonalds and KFC.

2) I believe the Koreans would kick us out as soon as they receive the materials for the next 6 months.

3) I believe MSF should withdraw as soon as the emergency needs of malnutrition are met.

4) I believe all expats leaving DPRK need psychological (or possibly psychosexual!) rehabilitation.

In November 1997, in a hospital of Pyongsong in the South Pyongyan Province, the MSF team discovered the existence of severely malnourished children, probably orphans that had so far been kept out of their sight. They had to fight to be allowed to care for these children. Then they tried to find out where they were coming from and to have access to more of them, in the other provinces.

INTERVIEW

At the beginning, during the first few weeks, we mostly received children suffering from moderate malnutrition in our therapeutic centres, always accompanied by an adult, who often gave nebulous, incoherent explanations. We didn’t have control over everything. Towards November, something changed. We gradually started receiving really malnourished children. It was proof of a slight opening on the part of the authorities. Until then, they didn’t reveal really malnourished children to international visitors. On our side, we suspected the existence, somewhere, of seriously malnourished children. During training sessions, there were always malnourished children around for demonstration needs, even children in a really serious state. But afterwards, the next time, we didn’t see them again. One day Brigitte [the nurse] was holding a training session. She left the room to smoke a cigarette and, unexpectedly, she spotted some children being taken out of the hospital in a cart. She stated to shout, asking where they were going. I don’t remember the exact explanation she was given, but from that moment onwards, we knew something wasn’t right.

The next time, in the same centre, in the same situation – we were always in the same building, but it was one of several – we decided to be a bit pushy. Brigitte forced a visit to the building next door. She discovered 30 to 40 children in a cold room, naked, piled up in a corner, children in the process of dying. It was an unimaginable sight. We knew there were problems; we didn’t understand what was going on. Brigitte said: ‘I want to see these children tomorrow.’ We returned together the following day. The situation hadn’t changed; the children were still there. The building was abandoned except for a room at the end, which had been overlooked and still had a bit of ground heating. There were piled up in a corner where there was a little warmth. We said that we wouldn’t leave until these children had received care. We asked for the building to be reorganised. We told them that we needed rooms for these children, beds, clothes, training for the personnel, and that we would come and see them every day and follow their development. This is when our working context got clearer, even if a bit of haze remained during the next two/three months, but this is the point when things took off in our province.

In December, Brigitte and I caught typhoid, and we were evacuated. We spent a good month in hospital, returning to Korea in January. But we asked other members of the team to continue following these children, paying them regular visits, and keeping us informed of their progress whilst we were in Belgium and France. From this moment on, the children started getting better. There was nothing really left to hide. I have all the information; we photocopied all the registers. We looked after about a hundred in this hospital. And all the children suffered from really severe malnutrition, with lots of oedemas. This was the first phase, the second being to know whom these children were and how it was possible they’d finished up in this state. The children were there, they were accepted up to a certain point. Every time we went there were more children. One day, we saw a group of 5-6 arrive dressed in rags, accompanied by one person. When they saw us, they started running away. We ran after them, we caught one. We realised that these children had no families, they lived in the streets, and they’d been rounded up and sent to this centre for nutritional recuperation. But the managers didn’t want to us to know that they came from the streets. So each time we were given the official explanation that they had families, but their parents lived far away. We understood immediately that this wasn’t the case. They’d been rounded up. They were in such a state; they had no strength left. It was the end of winter; they had practically no food resources. Because in the North Korean system, each person has his own ration of food in his own town, distributed in a pre-defined centre, so those outside the system have nothing.

Dominique Lafontaine, physician, MSF Programme in DPRK, August 1997 to September 1998 (in French).

INTERVIEW

The MSF Belgian team set up nutritional centres in one of the provinces near the capital, and by digging about – that was the point of this presence, for me, having doctors who could dig about – they came across children in a really bad state. It was striking that the children who came to our nutritional centres were effectively malnourished but always well dressed and accompanied by their mothers. In addition, the numbers were incompatible with any image we had of a famine raging through the country – they should have been far higher. We were sure that that the people trying to enter these centres were being screened. But it didn’t stop us. It wouldn’t have changed anything to yell at the authorities about this screening. We had to force the issue otherwise. The doctor at the time was very good at forcing. He complained that the population of children coming to the centre was not at all representative. One day he was shown a group of extremely malnourished older children, between seven and nine years old on average, in rags, naked, seriously malnourished, with swollen legs and chaffs on their skin. He wanted to start up an immediate emergency care procedure for these children, but the next day they had gone. He searched around for an explanation.

Dr. Eric Goemaere, Exectuive Director MSF Belgium, (in French).

INTERVIEW

These children had no parents whilst all the others had at least their mother or some other family member. We could really see that these children were outcasts. We were sure of this; because we saw what a lamentable state they were in when they arrived. Their skin was a disaster. hey came to us from time to time, sometimes from far away. It’s not easy to travel in Korea, there’s no means of transport.

Marie-Rose Pecchio, Coordinator, November 1997 to September 1998 MSF North Korea (in French).

In late November and early December, Eric Goemaere, MSF Belgium Executive Director, paid a visit to the MSF programme in North Korea.

DOCUMENT

“Some Questions after a Short Visit to DPRK,” Report from Eric Goemaere, MSF Belgium Executive Director, 15 December, 1997 (in English).

Extract:

1. As we are obviously in a military dictatorship, with little space for individual freedom, how can we justify our presence? [...]

3. For the MSF teams, it is important to keep in mind this totally unacceptable environment and origin of the disaster which is of course mainly man-made, whatever influence the natural disasters could have had in recent years.

The main principle in this kind of environment for humanitarian aid is to beware not to reinforce by any means, the control and exploitation exerted by an oligarchy on the people (‘the victims’) a principle usually referred to in our language as ‘first do not hurt’. In other words, MSF by essence, most of the time does not work in what can be called a democracy: the question is not there! But I would rather put it in “are we trapped through our work in the concrete block, or worse reinforcing it, or are we contributing to create cracks in it?” To be able to answer this question, they are several indicators like:

A: Essential

-Choice and direct access to the beneficiaries’ control of the aid distributed possibly by direct dialogue with local actors (doctors, nurse...)

B: Important (in the medium term)

-Possibility to address the real roots of the problem possibly to change the organisation of the health care system and drug distribution system in accordance with the needs.

2. Do we have now full access to the beneficiaries? Access has improved dramatically in the last 6 months according to the team. Geographically in the province where we are: we can now access the village level and visit clinics and more and more counties are open. Still we cannot go in all counties in the province (for ‘security reasons’). Interesting to see that leaders of those counties are now complaining at provincial level of not receiving aid like the others... More and more provinces become accessible every month: we where able to travel in North Hamgyong for the first time and UNICEF received authorisation last week for international staff based in Ryangan and IFRC just received a green light for Changan. No province is inaccessible but still some districts in provinces are. The main barrier we still face is the access to households: out of the question for the moment to enter households so no possibility to make any randomized nutritional or morbidity survey.

3. Do we control the aid distributed or does it go to the army or party leaders? This question is raised by every single journalist from Hong Kong to Brussels, to give the almost obsessive importance of it. MSF, since 95 and the first intervention linked aid with a totally new condition for them: presence of international staff on the field. This was then an enormous problem and seen has an arrogant attitude; it became normal today. MSF has done a pioneer job with a condition nowadays written in the ‘code of conduct’ made between agencies in Pyongyang for aid distribution. As our aid is therefore closely supervised by international staff; we can answer very clearly, that NO aid is going to beneficiaries outside the plan. Although we are not responsible for food aid, the information collected with WFP and EEC (DG8) are all-conclusive in the idea that food aid is fairly well distributed and that militaries have probably their own channels. But this of course is indirect, not systematic and therefore much less reliable information than what concerns our medical aid.

To resume the general impression, I would quote the UNDP representative, present in the country for 2? years: “One should not come to DPRK to look for massive leakages of aid; no system is totally waterproof but this one is probably the more in the area.” [...] In this environment, MSF should more than ever develop an image of independence. Independent, as far as possible, from the government at first (see above). Independent from the donors for which, aid is linked to political bargaining. The 97 program was financed at 95% by ECHO and 5% by the Norwegian government. ECHO will most probably have again a big share in the 98 budget as MSF is their best medical “window.” ECHO already warned that they would be reluctant to finance North Hamgyong and made it clear to the government... “If they did not choose ACF.” The opportunity should not be missed to show that we are not dependant on ECHO to start a new program. [...]

6. Is there a famine in North Korea like suggested by some reports? The food situation is year by year more precarious. We have not seen in N Hamgyong, supposedly particularly affected by the draught as they cultivate maize only (more sensible to draught than irrigated rice). We have no nutritional survey for the same reason and the one made by UNICEF/SCF in November (17% < 80% W/H) was performed upon children selected by the government. The only indirect “indicator” of malnutrition is the number of children who passed through our therapeutic feedings: >1,500 moderate and severe malnourished in 2 1/2 months, in 38 centres, which is not a dramatic figure. But seeing that TFCs are new for the population, transport problems, the fact that figures doubled in the last month, are indicating a crisis situation for a country where malnutrition was unknown. We have not seen a situation comparable with “millions of deaths” as describes, or “dead bodies” in the rivers, or infant cannibalism (rather stupid declaration knowing the Korean mentality for their 2 children/family). [...]

7. What are the key words for our medico-nutritional program? [...] Decentralise: we should focus the intervention on clinics (to restore from the basis a link with the population) with one referral level: the county hospital. Exceptionally, we should provide aid at provincial hospital level except considering them as first reference for the city population (if city county hospitals are dropped). [...]

8. Some additional remarks. We should consider an evaluation on the quality of water at peripheral level why did we not provide seeds this year as the 97 intervention has been much appreciated and needs are still there? One team of 2 international staff for a province with 15 counties if far below our criteria for good supervision and training. Last but not least, the international spirit in the team is far from good, each section giving sometimes more weight to their own representative than to the HOM.

INTERVIEW

It’s completely surreal, everything’s false 80% of people are fooled by it all. At least 20% have to be accomplices to achieve such a set-up and they’ve become so used to staging things that they no longer realise they’re doing it. There’s not even someone we can have a matter of fact discussion with, even in confidence, saying: ‘Yes, it’s all false.’ They don’t know how to differentiate true from false any more.

The MSF team welcomed me at the airport, but the officials were already there and I couldn’t get into the MSF car. I had to get into an official Mercedes where I was instantly given a bouquet of flowers. I was told: ‘this is to decorate the tomb of the great-venerated one. You forgot your bouquet, didn’t you?’ In Beijing, the plane for Pyongyang is always four, five, six hours late and sometimes it doesn’t come at all. So people don’t buy flowers in advance – a bouquet is expensive for a North Korean. And then suddenly you see everyone heading off to find a bouquet. That’s when you know the plane is arriving. You don’t know how they knew, but everyone disappears to find a bouquet because the Koreans cannot come back without a bouquet. They’re obliged to go and decorate the tomb every time they travel. So I was asked: ‘you forgot your bouquet, didn’t you?’ And a bouquet was placed in my hands. And then we rode with these two Mercedes on this desert road in the direction of Pyong Yang. There was nobody around and then suddenly, in the distance, there’s a sort of tower of Babel, a hotel in the form of a pyramid, which must be the biggest structure in the region. We stop on the 142nd floor; it’s completely empty. They spent colossal amounts of money on this hotel. A little further on, there’s a monument where I had to deposit the flowers. I refused to bend down. The guide had to push me a bit, making me stumble to give the impression of bending down.

I went there to visit a new province, North Hamgyong, which was considered the province most at risk, with the biggest problems; a province where no one had been yet. Following long negotiations with the authorities conducted by the Coordinator at the time, Jacques Tremblay, they allowed us to go on certain conditions. He had been negotiating our trip for months. He wondered what they were going to show us. It’s the famous province, which is separated from China by a river. Just over the other side, we could see China at road level, with cars driving along. On our side, there were no cars anywhere. There was no factory smoke. We went all round this province. Here again, everything was false. It was out of the question to have any unaccompanied contacts. The fact that we didn’t speak Korean made things much harder. We could only look around us and try and get an idea of what was going on.

My idea was that in this programme we had to break through this cover-up, force through it any way we could, until we went a step too far, and at that moment inch’ Allah. Whilst we were making advances, and advances in the right direction, it was OK, so long as we didn’t stop. Stopping meant being an accomplice. Here we were making advances, going to a new province, forcing a bit further. We’d said that we wouldn’t open a nutritional centre without carrying out a nutritional survey in people’s homes first. There are lots of doctors in North Korea and those poor devils. I’ve never seen such a state of dilapidation, I’ve never seen what I saw there, a hospital without even a tablet of aspirin. Not one! There were little pellet things, which were apparently used in traditional medicine. They used fishing line for stitches after operations. The conditions were apocalyptic.

Dr. Eric Goemaere, Executive Director MSF Belgium, (in French).

On 7 December 1997, on his way back from North Korea, Eric Goemaere held a press conference in Hong Kong. Bloody pictures of surgery performed by North Korean surgeons in very poor conditions (no anaesthesia), taken by an MSF physician, were shown to the press. MSF issued a press release focusing on the collapse of the health system and mentioning a food shortage rather than a famine. On 9 December, Eric Goemaere also gave a press conference in Brussels, delivering the same message, which was questioned within the MSF movement. www.video.9 - 10

DOCUMENT

“Forward Plan/North Korea Press Conference!” Email from Samantha Bolton, MSF International Communication Coordinator to MSF movement press officers, 4 December, 1997 (in English).

Extract:

1) NORTH KOREA - PRESS CONFERENCE! - This weekend Dr Eric Goemaere is coining back from North Korea on an assessment mission and will be passing through Hong Kong on Saturday through Sunday to do a press briefing with the international and local press on Sunday at 2pm HK time. This is am Europe time, so great for Monday paper deadlines. [...] The main message is to demystify the famine - that basically it is the result of the collapse of the communist system and that as far as MSF can see through the medical and nutritional work in 3 of the 9 provinces, the malnutrition levels are far from severe although there are medical needs.

As you probably have noticed, the Red Cross Federation has been doing a big fundraising campaign on the famine, but one of the dangers is that the Federation is run locally and cannot always work as independently (this info is FYI and not for public use). Peter Thysen MSF B comm is preparing a report on the situation, which will be distributed to all, although NOT for release until further notice. I am leaving for Hong Kong tonight, to work with Eric and the new Hong Kong, press officer on the press conference this weekend. Can be contacted through the Hong Kong office (Justine Gerald is the press, officer and is on ccmail). Will send you a better update asap and please stand by for the press advisory from Justine and for the info pack from Peter. This is potentially a very big story but must be handled with care.

DOCUMENT

“Communication North Korea – Urgent!” Email exchange between Pierre Salignon, MSF France programme manager, and William Claus, MSF Belgium programme manager, 6-8 December, 1997 (in French).

Extract:

From Pierre Salignon

Hi everyone,

We’re pleased to hear that Eric’s visit went well. Thanks for sending us the working document in preparation for the press conference. We read it with interest, and we consider it as a first draft. So here are some remarks/reflections on the text, but above all on the contents of the information, which we feel should be diffused or not. Don’t take offence, but we have quite a few remarks/questions. It’s up to you whether you take them into account or not. We’ve retained 3 points from Eric’s paper:

(1) It seems there’s no proof of famine in North Korea, but to date it hasn’t been possible to carry out a real evaluation (nutritional survey) of the gravity of the food problem. It seems that there’s a potential risk and problems of malnutrition in certain provinces. Yet it’s not always possible to have indicators allowing us to form a more detailed idea of the reality. So the situation is confused; the MSF teams have certainly seen cases of malnutrition, but are unable to draw conclusions on the gravity of the situation.

(2) There’s an important (structural) problem on the medical front. We were surprised by how you’ve formulated the message (as it’s a draft, we’re allowing ourselves to comment). He’s calling (this is the feeling we had after reading the document) for an increase in unrestricted international aid. In fact, on reading the document he appears to support the DPRK authorities, portraying them as open, in agreement with the free circulation of MSF teams (yet up to now this has never been the case in any of MSF’s 4 working provinces, or only to a very limited extent…) and encouraging the transportation of aid to the beneficiaries (we have doubts about the food).

(3) He asks the international community not to put conditions on its aid.

A final point, we are uncomfortable seeing in a paper intended for public distribution the announcement of a significant extension of our activities in the Northern Province, when this possibility was supposed to be discussed by the three sections intervening in North Korea on your return. The formulation of the document implies that this decision has been already been taken, undertakings given and that neither Paris nor Amsterdam have a word to say on the matter (ref my message sent to you and Alain Guilloux before your visit).

We have the impression here that it’s really important to remain prudent and articulate a public MSF message on North Korea, which focuses on several elements:

(1) Your account of your visit in the north as proposed;

(2) But underlining the fact that the situation varies according to the provinces MSF works in;

(3) That it hasn’t yet been possible (for the last 2 years) to carry out a nutritional survey such as we understand the term, and in the absence of serious indicators, it’s difficult for us to evaluate the gravity of the nutritional problem. Is there a famine or not? 1 or 2 million deaths? Difficult to reply. The only thing we can say without reserve: our observations in the field lead us to think that the food situation is fragile at the moment (but with only 350 children in our TFC out of a population of 6 million, we’re not going to talk about severe malnutrition). The causes are diverse (harvests, dependence on the outside world, cessation of Soviet/Chinese external aid etc., but also the North Korean system itself, over and above the embargo).

(4) This is why it’s important to make a public request for a real evaluation of the gravity of the nutritional problem, which hasn’t been possible to date due to a lack of authorisation and real freedom of movement (the visits to the north were perhaps more positive on this point…?).

(5) It’s difficult to give a real picture of the situation in DPRK.

(6) There’s no doubt that the population is suffering. The best illustration of this is the medical situation encountered by our teams in the hospitals and health facilities (whether or not it is for us to develop our activities in this domain is another issue to be discussed on your return. Idem for the limits of our intervention).

It seems more prudent to us not to announce an extension of our activities, nor talk about 8 million ECUs for ‘98 or an agreement with the authorities (we first have to discuss all this at operational level when Jacques returns). It seems contradictory to us to call for an increase in international aid when donors are already inclined to give a lot of money to this crisis. You talk of an embargo, but you don’t raise the difficulties encountered with the North Korean authorities, as if everything is fine (or at least this is the impression you give).

Which is why we have the feeling that limiting our discourse to the points above will create a much more balanced message in relation to both the local authorities and the media/international community. The risk of not being able to evaluate part of the humanitarian situation is important, and this should not be under-estimated when it will be the subject of MSF’s first position taken on North Korea, a country which remains one of the most striking examples of communism and totalitarianism this world has ever known. Your call for international assistance leaves the impression that there is not enough aid in the field (which is certainly true), but above all that the aid reaches the beneficiaries (we have more doubts on this point).

That’s our thoughts, in short. I hope you find them useful.

All the best

Pierre

From William:

Hi Pierre,

I’ve just received your reactions to the article. I don’t know if they’ll get to HK in time.

I find your message clear. Regarding our commitments in the north, I have no problem with what you say. We need to be on the ground before we can react. MSF now works in 4 provinces, which means we have a certain weight, which will give us a comfortable position for negotiations (re expats in the field).

WC

DOCUMENT

“The Health System in North Korea has Collapsed - Help is Needed Urgently but Needs Careful Distribution and Training of Staff,” MSF Press Release, Hong Kong, 7 December, 1997 (in English).

Extract:

“There are doctors and buildings, but no aspirin, no anaesthetic, no basic medicines, no heating, no soap and no milk and therefore no patients. The health system in North Korea has collapsed leaving almost the entire population with no care except for traditional ‘Korio’ herbal medicine and help is urgently needed” said Dr Eric Goemaere, Executive Director of Médecins Sans Frontières (MSF), who yesterday returned from an assessment mission in North Hamgyong, the northern most province of DPRK (North Korea).

But Dr Goemaere warned: “The international community must not make the same mistakes as in Bosnia and Rwanda and dump drugs, food and assistance indiscriminately. Distribution must be monitored and training is essential.” In North Korea there is 1 doctor per 300 inhabitants (in most western countries it is approximately 1 x 800 and varies elsewhere). But because there have been no supplies to the hospitals for the past 3-4 years, the doctors have not been able to help and patients have chosen to stay at home to die. Without patients, medicine and practise, the medical staff urgently need training in-patient care and drug management. Although it is accepted that there is food scarcity (Government and WFP data on crops, etc.), there are no visible signs of widespread “famine” like skeletal people collapsing from starvation in the street. However there are signs that food is a problem and that coping mechanisms are weak: people are scavenging for the last grains of rice after the harvest has been taken in, no markets, no fuel, no transport ...

Access around the country is improving, but full nutritional surveys to assess food distribution and levels of malnutrition around the country have still not yet been possible at a village or household level. In the three southern provinces where MSF has been working for the past two and a half months: South Pyongyan, North Hwanghae, Kangwon, 1,500 children under 5 years old have been treated for severe malnutrition in the 38 feeding centres MSF supports. Many were suffering from Kwashorkor or severe oedema (qualitative malnutrition - due to a lack of protein). Out of approximately 2 million people in the provinces, 1,500 is not a large number of malnourished children. What is significant is that the number of children admitted to the feeding centres doubled after the first month, as more and more people got to know that the hospitals and health centres could offer basic care once again. It is clear that there is a confidence crisis in the health system but that when the staff and supplies are in place, the patients come back. If drugs are to be distributed and distribution monitored, it must be at a county hospital level and not just at a provincial capital hospital level (e.g.: in North Hamgyong province there are 17 county hospitals outside the capital, each supporting 20 clinics for 2-3 villages each, or 2-3,000 people).

Dr Goemaere added: “Direct donations will never cover the needs of 23 million people. The assistance needs to be diversified to reach the needs of the people”. It is not just food and drugs that are needed but also seeds, tools, fertiliser and fuel and even the basic materials for restarting the four drug producing factories which used to produce most of the medicines for the hospitals. Dr Goemaere concluded: “In hospitals and village clinics I was impressed by the doctors’ motivation. Although access is improving steadily, aid agencies still have to obtain, from the North Korean authorities, greater access to those in need. On the other hand, those providing relief have to diversify the type of aid provided to increase North Korea’s capacity to produce food and drugs. If these steps are not taken, the people of North Korea will become even more vulnerable to famine and disease over the next year.”

DOCUMENT

“North Korea,” Email exchange between Anne-Marie Huby, MSF UK Executive Director, Anouk Delafortrie, MSF Belgium Press Officer and William Claus MSF Belgium programme manager, 8 December, 1997 (in English).

Extract:

1) Dear all,

Over the past few days, a lot of UK organizations have started raising funds for North Korea. Though it seems that these are ‘tactical’ ads, i.e. a way to show institutional donors that they are trying alternative sources of funding, there is bound to be more media interest in the next few days and weeks, so my question is: - which section is really in charge of our activities in NK?

-Which press office is in charge of info? Can anyone of you help? We really need a fact sheet on what MSF is really doing. I have read the sitrep, but it is pretty anecdotal, so we need to try and make sense of the information. It is becoming uncomfortable, to say the least, to have to tell journos that MSF has not encountered a famine while everyone else is crying wolf; if this is so, then we need to argue our case much better, many thanks for your help. Anne Marie

1) - Got the following message from UK, William, Jean-Marc, is there a co-ordinating section for Northern Korea?

-Is there a good overview of activities you could mail to me or I could copy?

Thanks

Anouk

DOCUMENT

“Follow up North Korea,” Email from Samantha Bolton, MSF International Communication Coordinator to MSF Press officers, 8 December, 1997 (in English).

Extract:

Dear all,

Samantha and Justine here. The press conference went well yesterday considering it was a Sunday and that the chicken bird fever press conference took many of the local papers away. The press conference started at 2pm HK time and lasted for just over an hour. We started with clips from the video and then Eric Goemaere spoke using overhead maps of North Korea and of the provinces visited. The press release was also translated into Chinese. Please see below - and read until the end! – Re: who attended plus follow up needed thanks and gros bisous

[…]Unfortunately, many of the correspondents were in Kyoto, Japan for the Environment Summit (as per usual Scandinavians and Germans are big on environment issues) - there are also not that many French based correspondents here - they are mostly based in Bangkok.

DIPLOMATS/POLITICOS - The following embassies/high commissions were represented: Russia/FIS Consul + Press Attache (asked Eric questions about ‘the grand master plan’ and how local political officials were behaving etc); the South Korean Consul (HY Song - who also requested a copy of the video - will give him the shortened copy as edited down by WTN - with only short medical extracts); US Senate Foreign Relations Committee (staff); special assistant to Martin Lee (Head of Democratic Party HK - opposition); Alliance Française (Henri Gerard - Editor in Chief “Parole” magazine).

2) OTHER INTERVIEWS/PHOTOS - WTN – pre-conference interviewed Eric and made a cut of the video for the world wide sat feed. Interview in English only. AP and AFP photo also took copies of the photos Eric took, to make copies for the international and local press use out of Hong Kong. Although not clear yet if any picked the pix up. AP has also agreed to make copies of the video for anyone who wants copies of our short, edit which was used to make the WTN edit. NBC also DHL’ed a copy of the MSF shortened version back to NY so that the producer there could check it out in view of doing the “1’15” personal point of view” clip (can’t remember the exact name of the program slot) […] Both video and photos were to be clearly marked MSF.

3) CONGRATULATIONS – Congratulations to the North Korea team and to Eric for getting the pictures in the first place – it is no easy feat in such a country and definitely meant that we had a bigger impact than we would have had otherwise. It was just after lunch and the press corps and dips present were really feeling queasy at what they were seeing!

DOCUMENT

“Invitation to a Press Conference, Médecins Sans Frontières in North Korea,” MSF Belgium, 8 December, 1997 (in French).

Extract:

Doctor Eric Geomaere, Executive Director of Médecins Sans Frontières, has just paid a visit to North Korea following information relating to nutritional problems. His visit included travel to the north of the country, to the province of North Hamgyong, which is a difficult region to access. He met the population and visited several hospitals, accompanied by Korean doctors and other members of the medical personnel. Dr Eric Goemaere will share his conclusions from this exploratory mission during two press conferences. One will take place in Hong Kong this Sunday, the other in Brussels at 11:00 next Tuesday, at Médecins Sans Frontières’ headquarters.

DOCUMENT

“Sick, Dying Refuse Treatment,” South China Morning Post (Hong Kong), 8 December, 1998 (in English).

Extract:

The health system has collapsed, with the sick and dying refusing to seek treatment from hospitals equipped only with traditional medicine, the head of an international aid agency said yesterday. Surgeons, working in soiled robes, were captured on film trying to remove a woman’s appendix with scissors and pliers. She died two days later. And a shortage of intravenous fluid systems has forced doctors to use old beer bottles as drips, Médecins Sans Frontières (MSF) director-general Eric Goemaere said in Hong Kong. The famine, combined with poor water quality and a lack of soap, had led to widespread respiratory ailments, skin disorders and diarrhoea, he added, after a week in the isolated Stalinist state. “There are doctors and buildings, but no aspirin, no anaesthetic, no basic medicines, no soap, no milk and, therefore, no patients,” he said. “They know they have nothing to offer them. The health system in North Korea has collapsed, leaving almost the entire population with no care except for traditional korio herbal medicine.” An MSF video www.video.11 taken at a hospital in southern Kwangwon province and screened here yesterday, showed a woman grimacing as doctors removed her appendix with only a local anaesthetic. Bound to her bed, the woman remained silent as the surgeons cut and tore at her skin with scissors and pliers because they lacked scalpels. They then inserted an already-bloodstained swab into the open wound to mop up blood before pressing ahead with the operation. “The woman had septic shock and after two days, she did not survive,” added the head of MSF, which has sent staff to North Korea since 1995.

The hospital was among those to receive MSF basic medical kits, including drugs no longer available in North Korea, but the doctors did not know how to use even the most simple drugs, said Mr Goemaere. ‘They didn’t know paracetamol, so we had to train them how to use it,’ he said, adding the hospital’s shelves were full of herbal medicines. His comments came as North Korea, South Korea, China and the US prepared to sit down for talks in Geneva tomorrow in an attempt to end the 50 years of war on the Korean peninsula.

DOCUMENT

“MSF/North Korea is on an IV Drip,” Le Soir (Brussels), 10 December, 1997 (in French).

Extract:

Returning from an exploratory mission in the north of the country, Doctor Eric Goemaere, Director of Médecins Sans Frontières Belgium, gave a more nuanced description of the situation to the press yesterday. “Whilst food is short, there are no visible signs of a large-scale famine” he observed. “On the other hand, the health system has collapsed. The figures collected for children suffering from severe malnutrition in the southern provinces where MSF has been working for the last six months are not that high” noted Doctor Goemaere, who denies certain accounts of abandoned bodies by roadsides. “It hasn’t yet been possible to carry out a complete nutritional survey with the aim of estimating the real degree of malnutrition,” he explained, “because access to families and certain districts is not authorised by the regime. Access to the populations is improving. MSF teams have recently been allowed to stay outside the capital.” The Belgian doctor was allowed to visit the health centres he wanted to see, particularly in the north, on the Chinese border, but he wasn’t allowed to go into peoples’ homes.

One thing is for sure: the situation’s alarming in the health domain. “There are doctors and lots of good will, and buildings, but no aspirin, no anaesthetics, no basic medicines, no heating, no soap, and no milk. And so, no patients. As no supply has been possible for the last three or four years, these doctors can’t help patients, who choose to die at home,” stated Eric Goemaere. According to the Belgian doctor, the floods and drought in North Korea are only part of the explanation. Natural and structural factors are combined, he explains. In the name of self-sufficiency, Korea has developed an intensive form of agriculture requiring a lot of seeds, pesticides and mechanisation. And at the moment there are neither seeds nor fuel, and the output decreases year after year. In the same way, the factories producing medicines are no longer supplied, and no longer produce anything.

“Certain countries try to keep North Korea’s head above water, but they don’t allow it to turn itself round. But we can’t keep a country of 23 million inhabitants on an IV drip for long. The slightest catastrophe and it will sink further still, and this will lead to the deaths of thousands of people,” concluded Eric Goemaere, for whom humanitarian aid cannot be linked to any political conditions.

DOCUMENT

“North Korea is not Suffering from Famine, but from Under-nourishment,” Dorian Malovic, La Croix (France), 17 December, 1997 (in French).

Extract:

“There’s no general famine in North Korea, no bodies or cannibalism… that’s rubbish,” protested the President [Executive Director] of Médecins Sans Frontieres (MSF), Belgian section, Eric Goemaere, following his return from an eight-day mission in one of the most closed off countries in the world. “This country suffers from malnutrition and its inhabitants are just managing to keep their heads above water. In one week, in the towns in the north of the country where the situation is really precarious, I only saw four or five women selling a few vegetables on the sly on street corners that’s all.” Authorised for the first time to visit the provinces in the north of the country, the MSF mission could observe the total collapse of the health structures: “There are lots of doctors in the hospitals I visited, but they have no medicines, infusions, aspirin, compresses […] and no more patients. People prefer to die at home.”

In the southern regions, where MSF has been working for several months, people are starting to use the dispensaries again because the organisation provides medicines. So the western doctors have been able to assess the state of the children’s’ health and make an initial evaluation: “We’ve observed that the number of malnourished children coming to see us (in an area of two million inhabitants) has doubled these last two months, passing from 1,500 to 3,000. There are shortages of protein, because the nutritional input of a diet of maize or rice is incomplete.” The combined factors of drought and floods partly explain this catastrophic situation, but the country’s entire economy is in a state of collapse: no factories are running, there’s no more petrol, no more electricity, everything freezes in winter […] for Eric Goemaere, increased assistance is needed with the guarantee that it will be distributed equitably (as the World Food Programme does), but diversification with local production is also required. “There’s a political stand off on this subject,” he said, “but Koreans must receive the means to restructure their production. Nonetheless, certain countries don’t want to see North Korea pull through. For me, we cannot leave 23 million people on an IV drip.”

INTERVIEW

The first account I gave in Hong Kong just after coming out of Korea aimed to describe what I’d seen in the province of North Hamgyong, the extreme dilapidation of the health facilities. It wasn’t supposed to be a denunciation at all; I was just relating what I’d seen. […] I aimed to describe what things were like for the victims in North Korea, to say that things weren’t going well at all and that humanitarian aid should be conditional to be sure that it really reached the victims. We were aiming to pressurise international humanitarian aid organisations into applying international standards in order to create enough humanitarian space to work correctly. At the same time I used this moment to raise the issue of the nutritional survey that had to be carried out and the selection of provinces and households it required. I’d also brought a film out of North Korea showing an appendectomy. There was no anaesthetic and the surgeon was shown from three different angles cutting ‘inside’ with a pair of scissors. The patient was given a cork to bite on. An MSF doctor filmed it. Why did they let him film? Because even in North Korea, we can play on the complicity between doctors. MSF was the first organisation to have teams living in the field, and we ended up establishing certain complicity between the doctors. There were fleeting moments when things worked loose from the control. But they were rare. These doctors were not torturers; that’s not true. They were really disturbed that, as doctors, they had to perform an appendectomy in such conditions. It’s not exactly ideal, with IV drips in beer bottles! No one felt worse about this than them and they ended up leaving us to film, asking themselves: “if this doesn’t bring in any help, what will?”

The projection of this film provoked a strong reaction. There are some highly important anti-Korean lobbies, and the film provided ‘scoop’ images proving that things weren’t going well in North Korea. But there were already quite a few people who suspected as much! We weren’t looking to put pressure on the government with this account. We had no illusions about the fact that the North Korean government followed press releases abroad. I have to say, as a general remark, that I find MSF often takes delight in bearing witness to denounce authorities yet frequently does it in places and at times that have no coherence with this objective. It’s often been done with the objective of drawing attention to ourselves and being able to claim afterwards that we told you so, making ourselves look smart.

Dr. Eric Goemaere, Executive Director MSF Belgium, (in French).

INTERVIEW

Eric created a real scene in Hong Kong, saying: ‘The hospitals are empty, operations are carried out without anaesthesia, people are dying of hunger, and aid must pour into North Korea. Yes we can ask questions about the regime. Me, I’ve seen what’s going on, I saw someone being operated without an anaesthetic, I’ve seen people being transfused with a bottle of water attached to a tube etc.’ He brought back some film. We were really disappointed by his intervention. I said to him: ‘It’s true that the hospitals are empty, but you went for sensation on something that doesn’t really warrant it. And you didn’t say the most important thing, which is that aid is used for everything except saving the people. This is where our responsibility lies. In saying that people are being operated on without anaesthesia, you’re not taking any real risks.’ At the time we were asking ourselves a lot of questions about the sense of assistance to North Korea, and I think they shared our questions, because we worked together, and they also expressed doubts. But in the end what emerged from his declaration was the scandal of shortage, the fact that it was a country short of everything. He insisted on the fact that we shouldn’t skimp on our aid to North Korea, that we should pull all the stops out. The North Koreans pretended to take it badly: ‘It’s great, we invite someone to our country and when he leaves, he says that we operate without anaesthesia; our image has been tarnished, etc.’ As for us, we just thought that he had got sucked into the North Korean regime’s game of propaganda, by supporting the idea that he was going to shut his eyes and bring in massive assistance.

Dr. Philippe Biberson, President MSF France (in French).

From late 1997 onwards, the MSF France team in China started to receive information, through the expatriate South Korean community in China, about increasing numbers of North Koreans fleeing their country via the Chinese border in a desperate bid for food and assistance in the northeastern province of China. The team started discussing this issue with François Jean, a Research Director of the MSF France Foundation. As this information (description of widespread famine, etc.) was contrasting so much with what the team inside North Korea could actually see they began to think about conducting an assessment of the situation at the border.

INTERVIEW

At the end of 1997, we started having discussions with François [Jean]. He took up contacts in Paris, calling on Sophie Delaunay who was the administrative officer for the Korean programme in Paris and knew South Korea, having studied there. He turned to her in the hope of finding something to explore in South Korea. He also looked at MSF Japan for the first time. We really started getting really interested in what was going on in North Korea following discussions with François, but also following descriptions of a reality which started emerging on a local level in Beijing, via the South Korean community expatriated in China, particularly via a network of South Korean friends I had there. There was more and more talk about these clandestine North Koreans who had left North Korea for China, where they came looking for assistance to survive. It was the first time we had heard famine being talked about so explicitly, deaths due to the famine and a situation, which was falling apart with hundreds or even thousands of people crossing the border.

We are at the end of 1997, beginning of 1998. With Marcel, we thought to ourselves that it could be interesting to go and see what was going on at the border, especially as all the accounts we were hearing at a distance - because we’d never been in person at this point, and never met a North Korean in flight. We’re very far removed from what we were hearing from our teams who had little access to direct information. The volunteers felt that something was going on. When we listen to Marie-Rose Peccio or Dominique Lafontaine, we could sense that they felt something was going on [inside the country], and we didn’t have access to it. At the time, we were leaning on our South Korean contacts in Beijing who were very connected with the South Korean network at the border, some of it religious, some of it not, and we decided to go and see what was going on at the Sino-Korean border ourselves.

Marine Buissonnière, administrator, MSF France in China, December 1996 to January 1999 (in French).

Meanwhile, debate and questioning resumed within MSF regarding the extension of the program in North Korea. A new MOU agreed to by the MSF Belgium programme manager was about to be signed with the FDRC, while the MSF France and MSF Holland programme managers were still requesting further negotiation. Once again, MSF France board members questioned the approach and the limits of the program.

DOCUMENT

“DPRK, North Hamgyong,” Email Exchange between William Claus, MSF Belgium programme manager and Pierre Salignon and Pierre-Pascal Vandini, MSF France programme manager, copy to Wouter Kok, MSF Holland programme manager and copy to executive directors and directors of operations, 9 January, 1998 (in English and French).

Extract:

From Pierre Salignon:

William,

We can’t hide our surprise and disagreement with your last message. We find your position unacceptable when we’ve just come from a meeting with you in Brussels during which we made our position clear:

1. No start up of a new programme in the northern province without imposing our conditions and so renegotiating our intervention with the authorities (particularly our work on clinic and district hospital levels, nutritional evaluation, access to the population, limiting and targeting the number of districts to be covered with 3 expatriates). We expressly asked for further discussions on these issues with you/the team before going any further with the ‘new’ MoU concerning the northern province and presenting it to the authorities (idem for the funding search). We don’t consider the new province as an MSF B module, and even if this was the case, it should not prevent us from discussing this intervention together as it will have a significant influence on the global strategy of MSF in North Korea.

2. No extension of our activities in the 3 southern provinces, which also require some streamlining.

3. Planning an MSF F and MSF H visit to the field as soon as possible.

4. Planning a discussion in April between MSF B, MSF F, and MSF H for redefining objectives for the post-July ’98 period.

Point 1 is essential for us because it influences the global strategy of MSF in North Korea. We never accepted starting in all 15 ‘counties’ in the north with just 3 expatriates in the field, especially as our positioning in the 3 southern provinces shows that the existing volume of programmes is no longer manageable with the number of expatriates we currently have in Korea (2 in each southern province…) or at least not in a way that satisfies us. It’s not just a question of having more expatriates. We first of all have to improve the definition of MSF’s objectives. They’re not very clear right now and require more work before we throw ourselves into a new province. You’re going to tell us that we’re in North Korea to supply essential medicines and medical material, ‘train’ the medical personnel and carry out nutritional activities. Fine, but is this enough? What limits/conditions (MSF’s principles of intervention) should be attached to this investment, whether in terms of volume, money or duration? Our strategy in North Korea is far from clear and it’s not by increasing the volume of our activities that we’ll get this sorted out. We haven’t got a grasp on what’s going on in this country (whether it’s the game being played by the Koreans themselves, the international community or, donors such as Echo). And that’s why we have to be prudent. We’re already one of the big players in North Korea, which encourages us think that we’re now in a position to try and discuss intervention conditions during our meetings with the North Korean authorities.

We asked you to use this argument to avoid developing new activities in the north without posing conditions beforehand (in particular access to the population, working at village level, nutritional evaluation and more targeted work at clinic and district hospital levels). The discussion on a new MoU for the northern province seemed a good opportunity to refuse to just dance to the North Koreans’ tune. Of course this could lead to tensions with the NK but we’re ready to deal with them. Instead you’ve put us, once again, in front of a ‘fait accompli’ without giving us a word to say on the matter, and we cannot believe that we can’t raise more issues with the North Koreans, as if our hands are tied. If this is the case, it poses a real question on our freedom to work in North Korea and the price to pay for being there. Contrary to what you think, we have the impression that now’s the right time to make our requests, our demands, even, to the NK authorities.

This mission has nothing international about it anymore. We’re really unhappy about these latest developments, especially when it’s so essential to present MSF as a unique entity in this country and the least you could do is take the positions of the other 2 sections working in the country into account. There’s our feedback. You know our position. We can’t continue to collaborate on North Korea in these conditions. Given our disagreements, we think that all decisions concerning this 4th province should be frozen for now.

All the best (despite everything) Pierre and Pierre-Pascal

DOCUMENT

“Korea and Frustrations,” Email from William Claus, MSF Belgian programme manager to Pierre Salignon and Pierre-Pascal Vandini, MSF France programme managers 11 January, 1998 (in French).

Extract:

Hi my friends, thanks for your feedback. A general remark on the international issue.

1. This mission was run by Paris for 2 years. I don’t remember having said no to the start up of a seed distribution programme last year. A programme decided by Paris, executed by Paris, and presented afterwards to Amsterdam and Brussels (fait accompli!!) Check it out in the archives. So I don’t understand your reaction on the international front. I have the impression that it’s fine when Paris is BUS [back up section] but once another section takes over, the tension starts mounting. How strange! Re your points:

1. As you had the funding for the start of the mission (Paris desk) I think that B should have the next round (see the email). You have the impression that everything is accepted without negotiation (at least, that’s my understanding). Yet I can assure you that Jacques had daily battles with the FDRC to win extra ground. As I’ve said – and this doesn’t show up in your message – one of our main objectives was to carry out an explo in the north. We did it (!) but there’s a price to pay, and in my opinion it’s justified. It’s not a bad thing to carry out distributions of medicines in empty clinics and hospitals! Is it against MSF’s ethics to supply medicines and start up nutritional activities??? Even if it’s in 15 counties (for your information, more than half the counties are situated in towns); so I see no obstacles to starting up this programme. Jacques will come to Paris in 2 weeks. You could question him further then.

It’s true, we’re already a major player but that doesn’t bother me. Is it a bad thing??? Whatever the case, it puts us in a strong position for future negotiations. (I hope your reaction isn’t based on worn out reflections on volume). I entirely agree with the second point. A visit from H and F would certainly facilitate understanding of the policy followed to date. If my memory serves me well, I was the one who proposed such a visit during the meeting. I think it should include the points you raise:

- Access to populations

- Nutritional survey

- Vertical approach

I hope that we’ll have enough data by then to come up with a good analysis (which isn’t the case right now). I’m sorry if there are frustrations but as Marc Gastellu says: “When we’re dealing with international issues, we sometimes have to accept or respect others’ decisions, even if they don’t completely reflect another section’s operational policy.” We’ve had to do it too. So I’m continuing as planned.

DOCUMENT

“North Korea – MoU/Objectives,” Email from Eric Goemaere, Executive Director MSF Belgium to William Claus, MSF Belgium programme manager and Email from Pierre Salignon, MSF France programme manager to William Claus, MSF Belgium programme manager, 22 January, 1998 (in French).

Extrait :

From: Eric Goemaere

Dear,

I contacted Bernard and Philippe in Paris to say that the inquisitions and ultimatums contained in the last messages concerning the DPRK go against the principal and delegation of confidence, two essential elements in any international set up. I see that this message has been passed on, at least with regards to the tone. Try this time, William, to adjust yourself to their change of attitude.

From: Pierre Salignon:

Hi William,

How are you? Well I hope. I attach the country fact sheet that I’ve drawn up on North Korea with Paris’ objectives for this mission. Concerning the annex of the MoU for the northern province and the 3 southern provinces, do you think it would be possible to introduce a few elements/requests, such as:

-Direct access to the population (access to village inhabitants).

-Freedom for MSF to target/re-orientate these objectives whilst limiting the number of facilities taken in charge (clinics and district hospitals for example); objective: introduce quality into our work.

-Freedom for MSF to decide which districts require particular targeting according to the nature of the needs and the organisation’s financial limits/capacities (you know my position on investing in 15 districts in the north with only 3 expatriates).

-Freedom of movement (perhaps we shouldn’t talk about the 2 or 3 days currently possible for visits in the districts, or ask for more).

-Possibility for MSF, after an evaluation, to limit its work, mainly because of the limited number of expatriates in the field. This does not mean, however, that if we are accorded more expats we will take more on).

-Freedom to evaluate the nutritional situation (carrying out an MSF survey, particularly in the villages).

Having said this, I’m aware of the constraints you described during our last meeting. Nonetheless this does not prevent us being more explicit in our requests and the 2 annexes of the MoU. Thanks in advance, all the best

Pierre

DOCUMENT

Minutes of MSF France Board Meeting, 31 January, 1998 (in French).

Extract:

North Korea: what approach to adopt and where are our limits? (Pierre Salignon) North Korea has completely broken down, with no local production and widespread shortages (food, medicines, health care etc.), mainly due to the political regime. MSF has opened programmes in three provinces since July 1997, distributing medicines and medical material, setting up therapeutic nutritional centres and training health personnel. The global budget (Holland, France and Belgium) for the period July 1997 to March 1998 amounts to 3.5 million ECUs, financed by ECHO.

The opening of a programme in a new province will increase the 1998 budget to 8 million US dollars whilst the government only authorises 12 expatriates. MSF was the first NGO to penetrate North Korea and develop activities there. Nevertheless, there is still a major risk that aid is being diverted without any control on the situation. The needs, which are huge, have to be measured up against the limited room for manœuvre in the development of our programmes. Certain people, including Frédéric Laffont, think it’s inconceivable that humanitarian assistance can be given in a country where a ‘perfect dictatorship’ holds sway; others think that we should organise a visit to the country as soon as possible to evaluate our programmes and then re-open the discussion; the second proposition was retained.

INTERVIEW

When we opened up in a 4th province, it sparked off a big discussion. The French were against this move because it over-inflated our financial volume. But they’d completely forgotten that they were the ones who’d negotiated all this financial volume. It was Marie-Pierre Allié [programme manager in July 1997] who gave the green light. So I said to the French: ‘When it was you, it was fine and now it’s us, it’s not.’ They weren’t being consistent. They were the ones who’d signed for the 5 million ECUs. As for the opening of the fourth province, there’d been an exploratory mission carried out by two experienced people who then proposed this programme. I didn’t have many arguments for saying no. I trusted them, and Paris did too. It was a lot of money, but I accepted the cost because it corresponded to a lot of material and medicines, which are expensive.

William Claus, MSF Belgium programme manager (in French).

INTERVIEW

MSF Belgium was the section that wanted to go further because for them it was a kind of distribution programme. We said jokingly here in Amsterdam, and I know that they did the same in Paris: ‘as long as MSF Belgium can fill up the shelves, they are happy.’ It looked like it was distribution driven - not driven by the real needs of the North Koreans but by the willingness to supply drugs. That was the image that we had here and that they also had in Paris.

Pim De Graaf, MSF Holland Executive Director (in English).

In January, a short article about MSF on North Korea published in the MSF France internal newspaper fuelled controversy between the sections. In North Korea, the members of the MSF team were experiencing difficulties in monitoring the aid and getting better access to the population. But in their field reports, most of them shaded these concerns, betting on step-by-step improvements and gradual gain of a space to work.

DOCUMENT

“North Korea,” The Mission, MSF France’s Satirical Internal Review, 21 January, 1998 (in French).

Extract:

North Korea - the Belgians are extending their programmes to fifteen sub-regions in the north for a vast supply operation. So for the year ’98, the World Company’s budget (3 sections present, MSF F, H, B) for this country alone will border on 50 million francs. Forgive us for being a bit circumspect in view of how enormous this is. Not because we’re against it on principle (that’s not our style) but because it feels a bit like we’re being taken for a ride (with all respect): no evaluations worth their salt have taken place in the areas in question, so the situation isn’t very clear; the North Korean government is obviously very keen that MSF extends its programmes, it’s good for its image, and incidentally good for its stocks; and ECHO, who’s funding us (with even more than we asked for), has found, via MSF, a cushy number for getting its cash into one of the most closed off countries in the world. I don’t know about you, but I think this smells bad. The other small problem, but only a small one, is that for such a huge financial volume, MSF B can only put three expats in the field. Buy hey; it doesn’t really mater, given that contact with patients is forbidden.

DOCUMENT

“Mission Impossible in North Korea,” Emails from William Bourgeois, MSF Belgium programme manager and Jacques Tremblay, Coordinator for MSF North Korea to Pierre Salignon, MSF France programme manager, 29 January, 1998 (in French).

Extract:

Allow me to comment on the nonsense appearing in “The Mission” of January 21, 1998. I would just like to say that this kind of stupidity really doesn’t help the cause of MSF. […] I’m not sure whose opinion within MSF F is reflected in such rubbish – the article confuses ‘I’ with ‘we’ […] Could you forward this alternative view of the situation to whoever is concerned?

North Korea (Mission Impossible)

Surprise surprise: the “Belgians” aren’t extending their programmes but the programmes of MSF. […] In the north of the country, after 6 months of negotiations in the name of MSF for bringing aid to a population in difficulty. […] You’re not against on principle, sorry, but in the field we have quite the opposite impression. For sure we’re being taken for a ride (with or without respect). And lest we forget: following the tact and diplomacy exhibited by the master hand in 1995, MSF was given its ‘exit visa’ from Korea, perhaps a new way of going about evaluations “worth their salt” at a distance. [...] As for the bad smell, I give 10/10 in the odour stakes to the author of this shit on Korea. He/she deserves a good dressing down for displaying such ignorance on the subject and contempt for the teams in the field.

Moving on,

-ECHO doesn’t finance this programme (in the North) and MSF will have not 3 but 13 expatriates for its programmes in Korea (not easy to count to 13 with just ten fingers, I know)

-the MSF B team arrived at the beginning of the programme, not 3 months after the start of a 6 month programme. […] The ‘MoU’ for this programme was signed under MSF F coordination, we should know what we’re looking for when injecting ‘cash into one of the most closed off countries in the world‘.

-it would be a bit pretentious to think that we can change everything without any direct involvement, except perhaps for a musketeer of disinformation. And if we could bear in mind, however strange it might seem for certain holier than thou persons, that the medicines we distribute really are used by a population in difficulty that doesn’t give a damn about the petty quarrels between sections or individual (donkey) pride...

DOCUMENT

“Those Bad French Smells,” Email from Marie-Rose Pecchio, new Coordinator, MSF DPRK, to Pierre Salignon, MSF France programme manager, copies to programme managers of MSF Belgian and MSF Holland, 31 January, 1998 (in French).

Extract:

Following the reaction of Jacques Tremblay, the ex-Head of Mission, here’s mine, the new Head of Mission, in reference to your insults to the MSF team in Korea. [...] I have a suspicion that at the end of the day, all this brouhaha about North Korea is nothing more than a pitiful inter-section squabble, once again. The wee Frenchies aren’t happy because the wee Belges have got the coordination: we’d do a much better job if we were in your place. Do you realise that MSF has been here for 6 months and we haven’t been thrown out yet? Weird! Things moved so much faster last time. And do you know what, we can visit our patients, touch them, discuss their treatments with them, check that our medicines are used properly. And we’re still allowed to stay, despite it all. If it’d been us, we’d be packing our bags after a couple of months, and who cares that the Koreans need help. That’s not what we’re here for. We’re here for Global Strategy.

Messieurs les French, you should know that feudal times, when the aristocracy fought to keep hold of power and privilege, are over – and have been for about 500 or 600 years, I believe. We’re in 1998, and we’re trying to build something called MSF, or more precisely MSF International. I think we’ll manage it, with or without you. It’s high time we do. You remind me of the English who did everything possible to derail the European Union, but it went ahead anyway, despite their efforts. I’d be so happy if we could sometimes, just sometimes, talk about the main reason for our presence in Korea. It’s called BENEFICIARIES. For those who don’t know what a beneficiary is, look it up. I’m afraid there are quite a few people, ‘MSF bosses’ hidden in their offices, who’ve buried this notion of beneficiaries under an utter mess called Global Political and Operational Strategy. The beneficiaries, here in Korea, are the poor souls crushed by a system of such unimaginable inhumanity that it’s completely beyond them. All they know is that their children will die because there are no medicines to treat them. A bit sordid, sorry, but it’s the reality in a nutshell, far removed from any kind of Global Operational Strategy.

The hospitals were empty during the teams’ first field visits: no patients, no personnel, no medicines – no nothing, to cut it short. After 3 months of distributing medicines and training, there are patients again, receiving treatment. I’ve just come back from a field visit in North Hwanghae province: I went round all the patients with an expat doctor, we checked the prescriptions, and we went through the pharmacy. People are being treated, and not too badly either. And I think it’s thanks to us. As for the 10 million USD we’re spending in ’98 – I think it’s not enough. We need double, given the dilapidated state of the hospitals and dispensaries. Over here, we can justify our imports to the last tablet of aspirin (except the five I gave to the DG8 representative). Can we say as much for our other missions?? I’ve carried out 14, during 7 years with MSF, so I know what I’m talking about. And if ECHO wants to ‘get its cash’ into the country, and so subsidises our work which allows us to reach our objectives, I honestly don’t give a damn. Whether it’s Khomeini, the Pope, God our Father or Gorbatchev, it’s all one and the same to me. And all the better if others want to give still more money for medicines and medical material. I’m all for it because we, MSF, can see ‘with our own eyes’ what’s been done with this material and cash.

In conclusion, I’d like you to know that I’m sick and tied of your childish stories, F-H-B. I’ve got so many better things to do. Above all when such low-level debate does nothing to advance MSF’s international issue, and even less so the organisation itself. I’m ashamed to belong to the same organisation as this anonymous figure, which doesn’t say a single word about the Koreans MSF’s trying to pull out of the dirt, unpleasant though that thought might be. I’m ashamed, as Head of Mission, to pass on Paris’s elevated opinion of our expats’ work in the field over the last few months. Here, the MSF field team is entirely composed of first missions. If this is MSF F’s new strategy for building up HR loyalty, then guess what guys - it’s working.... Thanks for nothing, headquarters.

DOCUMENT

“Monthly Report from 23/12/1997 to 31/01/1997 – Medical Report, North Hwangae Province,” Herbert Raajmakers, MSF (H) Physician, 31 January, 1997 (in English).

Extract:

General discussion

-Extension of the North Hwanghae province with 4 more counties. Personally I believe it’s possible to extend the programme in the North Hwanghae province with the 4 counties of the IFRC with the same staff. I have done already a lot of training in the province so my successor will have some time to take the extra counties. I also believe that it’s more effective to take the extra counties and then ask for extra people than vice versa.

-Recently we received an article, which was published in “The Mission” of MSF F. Unfortunately the article was anonymous so I can’t reply the author personally. I can only hope that he will take the effort to read the reports we write about our job but I am not so optimistic about that. In the article the author mentioned that we aren’t able to touch the patients. To correct that misunderstanding I want to explain what we can do and what we can’t do. The last 4 months I have visited hospitals and ri-clinics almost every day. During those visits we look at the patients, we talk with them, we examine them if necessary, we look at the medical charts and we discuss the treatment with the doctors. We also go to the operation rooms and see operations. Of course we go to the pharmacies and the warehouses to look at the drugs.

As I mentioned in my earlier reports we have reasonable freedom to visit the health structures at random. Every week the situation improves and the atmosphere becomes more and more open. We are not allowed to obtain objective data about the health situation of the people. The data we have received so far are not reliable. Of course you can question our being here and if we should expanded our programme. But that discussion should be held openly and be based on facts not by an anonymous person who don’t have a clue what they are talking about.

DOCUMENT

’The Mission,’ Putting Things Straight,” Email from Bénédicte Jeannerod, Communications Officer, MSF France to Jacques Tremblay, Coordinator, MSF North Korea, 2 February, 1998 (in French).

Extract:

Message for the attention of Jacques Tremblay from Bénédicte (The Mission)

Hi Jacques,

I never imagined that this issue of the Mission would kick up such a storm. Sorry, but there are debates on the issue here. They concern:

-The considerable financial volume deployed by MSF in certain missions (particularly in North Korea, but not only – ref Angola); nearly 50 million francs - that’s a fifth of MSF France’s annual budget.

-ECHO’s monopoly over certain MSF budgets.

-The imbalance between the huge financial volume deployed in North Korea and our proportionally weak presence in the field.

-The difficulties of carrying out uninhibited explos and having unrestricted access to the population.

These questions have been raised during your discussions with other sections. And you don’t all agree with the approach adopted. There’s no benefit to hiding these things. On a more general note, our dependence on ECHO and the size of our budgets generate big discussions within MSF. These questions do not raise doubts on the quality of our volunteers’ work in the field, nor on their good faith, their generosity, their motivation, their competences etc. You know very well that this isn’t the issue. The work achieved by our volunteers should not be a pretext to kill a debate. The real issue at stake is the mission’s general strategy, the choices made by directors, and not everybody has to agree with them. You and I both work in an association adhering to freedom of speech. An association, which depends on questioning certain choices and the capacity of its members not to take themselves - too - seriously. That’s the name of the game. Don’t get in this frame of mind because of ‘The Mission.’ And, don’t ask for this review to be politically correct or indulge in double speak. On the contrary, it aims to put its finger on sore spots and make us laugh. I hope we can put this behind us.

Bénédicte.

PS: ‘Messages,’ the (real, serious) internal review, is open for debate on MSF’s intervention in North Korea. You’re welcome to contribute your opinion. I’ll do a rectification in the next ‘Mission’ on the number of MSF expats in the field. And I’ll try, as far as I can, not to mention sections, but just ‘MSF’. MSF F is also caught up in this North Korean adventure.

DOCUMENT

“MSF DPRK,” Monthly Report from 01/02/1998 to 28/02/1998, 28 February, 1998 (in English).

Extract:

Minutes [of the] team meeting about […] Medical Project progress

-Drug distribution as performed until now is satisfactory. The drugs are in the right place, with only small exceptions. Most of the doctors prescribe them in the right way. The training, how to use them has, been picked up [learned] adequately. The impression is that the doctors have enough basic knowledge to use them in an appropriate way. The patients numbers visiting the hospitals are improving (as is the weather), we therefore are also able to monitor the diseases in our provinces in a better way. (How?) Relations/contact with authorities is good, it is clear they trust us more and more. It is seen as very positive to be present in 4 provinces, to work on a broad scale. But we worry about the Korean medical system, that it is not sustainable, and that MSF will never be able to make it sustainable as well...

Future ideas

To be able to make decisions on which we will focus on the future, it is generally felt that we first need clarity about the project objectives and aims. The drug distribution in the 4 provinces is good/necessary, by which we get a general idea about the morbidity (maybe enough?), but monthly morbidity-data gathered never will be reliable when there is only one doctor per province. For that, we better can concentrate on taking care of one county per province, and garner better data by a common presence (but can we extrapolate that to other parts of the country?). So are we giving priority to large scale/less reliable systems, or small scale/more reliable information? Maybe we can do both? [...]

1.1 MSF B by Dominique Lafontaine

Monthly medical report for the South Pyongyan Province – February 1998 [...]

Monitoring

During our field visits, we can now go deeper when we collect information from our guests. There are still a lot of touchy points, but step by step we begin to understand more and more on the system prevailing in this country. We will never reach a complete understanding but some of our problems can be put in a better perspective than before. It is the case with the monitoring of the drugs distribution. Actually, we have the clear impression that a lot of drugs are withdrawn from our control and held in a special stock. That means that not all the drugs are delivered to the population in the present time. We think and I’m personally persuaded that the intention is not to keep away these drugs for a negative purpose but to use them later after our departure from the country. MSF will leave the country one day without any replacement. North Korea is always in a war-game and the general mentality is always to keep in stock the essential stuff as the food and the drugs. The given explanation doesn’t satisfy us, mainly because we are not sure that the population’s needs are fulfilled by our programme. Nevertheless, when we push the different responsibles we are always (until now) able to see the hidden stock. That means clearly that the distributed drugs are at the right place but not fully used until now. The unanswered question is to know if they stock because the population consumption is lower than expected or because there is a real willingness to do it even if the population needs the drugs. Our attitude will be totally different according to the answer.

We continue to collect the consumption and the morbidity forms during our regular visits to the health centres. The existence of the hidden stock means that the reliability of all consumption data are dubious. As in their mind there is a link between these consumption data and the morbidity data, it’s clear that the morbidity figures are also totally wrong. To have a better understanding of the local morbidity and of the drugs consumption, we plan to analyze in a deeper way, the prescriptions made by the Korean doctors. These are a wealth of information as they give the diagnosis, the chosen drugs, and the number of prescriptions each day (so, roughly, the number of consultations). They are kept in reserve for putative control during at least three years. So, if we have access to the six last months, it will be possible to demonstrate the impact of our programme. [...]

1.2 MSF H: by Herbert Raaijmakers

It is not a monthly report by this final report. Medical report North Hwanghae. Period: September 1997/February 1998 [...]

The programme

My personal feeling is that the programme has been a success. The drugs we have distributed have reached the people who need it. The use of the drugs and of the medical equipment is reasonably good. Of course the doctors need more training and information about the drugs and treatment of the diseases but they are eager to learn from us. The collecting of data to prove this is much more difficult. As I have told before they have their own system of stock keeping and their own forms so maybe we could use them. For the moment the only way to check if the distribution is done well is to go into the field. For the future I think it is important to decide what our priorities are because we can’t support the whole health system.

My personal feeling is that we should focus on the ri-clinic level, We simply don’t have the means to support all the hospitals and we will reach many more people by supporting the ri-clinics than if we focus on the hospitals. During my stay in the DPRK, I have noticed more openness and trust between the Koreans and MSF. For me it’s important that this process doesn’t stop and the main condition for the extending of the programme. One of my main disappointments during the last five months was the lack of cooperation and trust between the three MSF sections. If you decide to act as one mission in the DPRK than do so. At the moment there are three different policies, three different budgets, three different salaries, three different per diems, three different R&R arrangements, etc. Needless to say that this put I lot of stress on the team. I believe that the responsible persons should act more professional on this matter.

1.3 MSF F: Rickard Ljung. Medical report Kangwon Province February 1998 [...]

The difficulties with distribution are not only lack of transport. In my province there is, as seen above, a deliberate change made in favour of some hospitals. This month has been disappointing for me; I have encountered more problems than before with the monitoring of the drug distribution. [...]

Data

I have received the drug consumption lists and morbidity charts per county for the month of December. As suspected the figures are not reliable. When told about this the director of public health admitted that the numbers were fake. […]

Access

The winter is turning into spring, the snow is nearly gone but the roads are still very bad due to mud, despite this we have been able to visit all counties. We have visited the orphanage of <5 years and the one for >5. We have repeatedly been denied access to the TB sanatorium.

Future

[...] The objectives and the strategy of this mission are still very unclear. I have been here for three months and I don’t know if I really did something sustainable or if I am just here for distribution and ‘drug dumping’. As said before I see a need for medical coordination and also cooperation between the three desks. [...]

MSF H: by Inge Verdonck. In fact, it is not her monthly report but her final report. [...]

Background on working conditions, Introductions and counterparts

In North Hwangae the people already knew MSF from an earlier mission is 1995 in the county Unpa. They therefore already knew what to expect from us, this made the introduction easier. During our first round to all the counties we were accompanied by the head of the provincial health department. During the following months we would see him regularly and discuss the programme and the problems with him. We only met the head of FDRC a few times during the first weeks. ln the counties we were normally accompanied by the director of the hospital, the head of the health section and sometimes (vice) chairman of the county. This made it easier to discuss more general health issues. The negative side of being accompanied by so many people was that it was sometimes impossible to have discussions or training with the doctors or patients. In the other provinces the teams were accompanied by other people. For instance in Kangwon they had, in the first months, a doctor with them who could initiate actions (like replacing non-functioning heads of wards), which was more difficult for us.

Access to health structures and other institutes

We normally went four or five times a week to the counties. We had to present our weekly programme on Friday morning a week ahead. We had no problems with access to the counties and hospitals. Although most visits were therefore pre-arranged, sometimes we would come unexpected because the county was not warned in advance by the FDRC about our visit, in which case we did not notice much difference in the situation (people were only less prepared and we had to wait longer till doctors were ready to show us around). It was more problematic to have free access to the climes if we wanted to do random visits. Partly because the road conditions were not good enough, and partly due to lack of time (may be intentionally caused by the counties). We could do some random visits, but we had to fight for it. We could visit nurseries when we put it in the programme (not at random, they are not under the department of health). We also regularly visited the provincial orphanage for younger children and once the orphanage for older children. We could not visit any other health structures (disabled, retired, TB hospitals). We tried to arrange visits through provincial level (impossible because they do not fall under the department of health, our counterpart) and through FDRC in Pyongyang. We were not allowed to go anywhere by ourselves, but had always one of the translators with us.

[…] Gathering background information

During our visits I interviewed doctors and patients. Most of the information was not very useful because of several reasons:

1. Nervousness: Especially during my first visits most people were too nervous to answer me because it was the first time they saw foreigners and because many higher officials accompanied us. Later this was hardly a problem, since the doctors had at least seen us during the training, and patients had heard about me from other patients. The faces of patients showed that they were even disappointed if I did not talk to them.

2. Instructed answers; I had the clear impression that the doctors were instructed beforehand on what to answer to us on certain topics, since all gave the same answers. […]

3. Lack of knowledge: Some answers were doubtful because probably the doctors were also not aware of the real situation. For instance, the percentage of malnutrition and the number of patients seen did not fit (the doctors did have not a real idea about the percentages of people with a disease). And probably no one knows the real malnutrition figures because no one did systematic research on it.

4. Politics: Many answers are politically sensitive, so that reality cannot be discussed.

5. Expectation: Many times doctors say they do not have something because they presumably hope MSF will provide it (add this to the problem of politically sensitivity to admit that they do not have something, and you will never know how to interpret an answer).

6. Systematic information: We had permission from the head of the department of health to distribute a questionnaire to all doctors of the clinics during the training (mainly questions on morbidity figures). But after the first time, when FDRC in Pyongyang heard about it, it was forbidden to ask these questions in this way. We could only ask it in individual interviews in clinics, probably because this would give less systematic information.

7. Interpreters: Last but not least, all information goes through the interpreters. They might change some information because of political reasons. They might forget to translate things because they do not understand this might be important for us. They might translate our questions differently (for instant in a suggestive way) because they do not understand interview techniques. Their English is not good, so that they have often problems to translate correctly. […]

Evaluation of the nutrition programme

I think the description of the nutrition programme is a little meagre. The fact that there are no objectives makes evaluation problematic. This might be in the MSF philosophy: “We just go for it.” However, after half a year of “going for it,” I think I spent a few minutes on reflecting on the programme. […]

Need for better project design

As stated in the beginning, I think the design of the nutrition programme is a bit meagre; it only describes an assumed problem and two solutions. It misses all steps in between. I can understand that this information was not available at the time the MOU was drafted. But I would have expected that a more complete proposal would have been written for the 3rd phase, because without a proper programme design one can expect more problems in the implementation of the project and one has a high risk of failure in reaching one’s aims. I think we are still in a phase that we do not know exactly the extent of the malnutrition problem or the causal factors. I therefore think that one of the objectives for the next phase should be to gather more information. [...]

Evaluation of working for MSF in the DPRK

The main problem during the first months has been the MSF coordinator; his lack of communication made it absolutely unclear to me what MSF was doing here or planning to do. In comparison, the Koreans were easy to communicate with, which made it a joy to go to the field. So in that way the coordinator had a very stimulating impact. In December we got a new coordinator, which improved the situation. However, understandably, it took some time before she was completely introduced to all aspects of the programme. So now I am leaving, finally the nutrition programme can be discussed. The work in DPRK has been very interesting. The work has been very diverse, practical and rewarding. It involved getting an understanding of the actual health system, and adjusting to this in the most suitable way to get an effective programme. The close collaboration with doctors in many institutions was very interesting. The work in different hospitals gave a diversity of experiences, which gave many in-sights in the functioning of the health system. Although the system, the suspicions of the people and difficulties to get real information, were often tiresome, I very much liked to work with the Korean people. The doctors are very motivated; it is encouraging to see how they do their best under such difficult circumstances. It is a pleasure to provide them with the means to do their work well, and to see the impact of our inputs on the treatment of the patients. It is heart-warming to see their gratitude and hospitality towards us. […]

1.3 MSF F: Fiona Laird. [...]

[…] Orphanages are generally referred to as children’s centres, although not all of the children present are orphans. Some children will attend if they come from single parent families, and the parent cannot care for the child adequately, or if demands of work are excessive. There is one children’s centre in each province. Apparently children from the age of 6-11 go to a centre in ‘the north’ and then return to Kangwon province to the secondary children’s centre when aged 12-17. This nomenclature confuses me too! […] The children’s centre has 280 children, from 0 to five years old living on two sites. Until today, I had visited the centre about once a month, and was unaware that the second site existed. The condition of the children in this house is distinctly worse man I had previously seen, and many of the children look to be developmentally delayed, as well as undernourished, and suffering from minor diseases. There are usually about fifteen to twenty children in one room, with one-carer/nurse. Therapeutic milk is given to the majority of the children. The director of this centre is very charming, and appears to care for the children, however, I believe that this institution would benefit from more regular attention from the agencies.

Until recently the existence of the institution for older children had been denied. In part, this seems to be because the orphanages are an emotive subject and attract a lot of attention from would be humanitarian sightseers. There has therefore been reluctance to allow entry into these institutions, but this further fuels speculation about the condition of the children. The Kangwon secondary children’s centre apparently houses 800 children, and the building is very large, so this could be possible. The director commented that the government provides food, but there is not really enough. 15 children have been referred to the provincial paediatric hospital for therapeutic feeding, and another 30 have been treated in the centre. In a classroom, two children looked as though they would have benefited from therapeutic feeding, but there were also many adolescents playing ball games outside who looked fit and well. It is my biggest fear that we have unknowingly walked past rooms full of wasted children, but so far the impression from both visits is that these children are living in reasonable conditions.

The Working Context

[…] Communication is not always easy. There is often a reluctance to admit to problems, to get direct information or feedback, and sometimes there is evidence of an ‘economy of truth’. Data is unreliable, and one county has given different data on three successive visits. Usually these problems can be overcome or dismissed quite easily. Unfortunately, there have also been elaborate charades, using malnourished children as the players, which are tragic, and disturbing to witness. Severely malnourished children are seen in a TFC, and then disappear, presumably back to the institution they came from. In all cases where this has been seen, the children have looked particularly uncared for, with shaved heads. In Kangwon, I have seen this once only, and there were significant improvements made to the ward, including a change of staff, after I discussed with the director of the hospital that this was unacceptable. But these children still exist somewhere.

Distribution of the medical kits has not brought about the improvements in healthcare that would be hoped for. The storerooms often remain full of unused equipment. Usually the paediatric ward has one pair of gloves, if any, and systematic drug treatment of malnourished children requires constant pushing. The paediatricians are usually restrained by the instructions of the director of the hospital, but in turn, he too, is probably under orders. One doctor explained that he was using inadequate amounts of milk, because an official (of what department?) had told him to use less. Unless this mentality changes, the work of MSF will never be successful in this country.

MSF

Until Christmas, working conditions within the MSF team were very difficult. Communication breakdown between the head of mission, and the MSF France doctor, Payam Fazel, led to Payams’ departure at the end of October, and left a legacy of disunity. An internal cold war existed within the team, and communication from the head of mission was negligible, or within MSF Belgium only. On a personal level, working in a country that is secretive, suspicious and mistrusting is not easy, but for me there was a feeling of: “We have found the enemy, and it is us.” Professionally, lack of communication has more significant implications on the effectiveness of the programme. The medical/nutrition members of MSF-F and MSF-H were on their first missions with MSF, and experienced leadership would have been welcomed. Now that communication and support are improved, the programme is gaining cohesiveness and direction, allowing a fuller analysis of our work.

The Future

The current nutrition programme was appropriate when MSF first started working in DPRK, and there is no doubt that it has prevented the deaths of many children. This has been stated by the hospital staff. However, I think that it is now losing effectiveness, and if numbers in the TFCs continue to fall, it may become difficult to justify continuing. I think steps need to be taken quickly, to adapt to the needs of the children being seen in the TFCs and to reach those children not being seen. The proposed supplementary programme using dry rations seems appropriate, but needs to be implemented soon. MSF has been privileged to have relatively large numbers of expatriate staff in DPRK, and has had comparatively excellent access to the medical structures and the population. We therefore have the most experience in implementing therapeutic feeding in DPRK. For this reason, I believe we have a lot to offer the children’s centres, and would like to increase the level of support that we can offer them. At the moment, doing so does not look easy, but having seen the children; I would fight to do it.

DOCUMENT

Letter from Fiona Laird, MSF Nurse in North Korea to Pierre Salignon, MSF France programme manager, 28 February, 1998 (in English).

Extract:

[...] At the moment I am feeling very disillusioned with this programme; I think it was originally well planned. But, we still do not really know what is happening in terms of malnutrition, milk is not distributed and less and less children visit the TFCs. It makes me wonder what we are achieving. Similarly, the hospitals use some of the drugs, but we do not know if they use them correctly, and a lot of the equipment remains in storehouses. I do not want to be too cynical in my report because I believe we have achieved many things, at least feed over 2,000 children. Also I know that my view is influenced at the moment by the difficulties of working in this country. I do not think that you will experience this in two weeks, but lack of freedom, is very oppressive, and everything we do is controlled. As individuals we are puppets, but it is very important that MSF does not become one. I will be interested to hear what you think after visiting here. I hope to see you in Paris, at the end of March.

On 5 February 1998, following an appeal launched by the WFP in early January, the US State Department announced 75 million dollars in food aid to North Korea. DPRK authorities subsequently accepted the doubling of the number of WFP aid workers in the country.

DOCUMENT

“US gives 75 Million Dollars in Aid to North Korea,” Sarah Jackson-Han, AFP (France), 5 February, 1998 (in English).

Extract:

US Give 75 million dollars in Aid to North Korea by Sarah Jackson-Han, WASHINGTON, Feb 5 (AFP) - The State Department on Thursday announced 75 million dollars in new food aid to North Korea, its largest single contribution to date to the struggling communist country. The money, channelled through the US Agency for International Development (USAID), follows a new appeal by the UN World Food Programme (WFP) and an agreement by Pyongyang to sharply increase the number of international aid workers in the tightly closed country. It will be used to buy 200,000 tons of grain targeted at “North Korean civilians that are most vulnerable,” notably children, State Department spokesman James Rubin said.

The WFP last month launched a drive for 378.2 million dollars in food aid, nearly double the amount requested for 1997. The US share of 75 million dollars will be provided in three tranches from April 1998 until March 1999, Rubin said. Previous US food aid to North Korea, since 1995, has totalized nearly 71 million dollars, including 65.5 million dollars to the WFP and 5.2 million dollars to UNICEF. Under an agreement with the WPF, North Korea has agreed to double the number of WFP staff in the isolated Stalinist country to 46 people, including 26 food monitors, USAID said. The WFP will also open two more regional offices in North Korea charged with overseeing deliveries, the agency said. A senior US official who asked not to be named said the new offices would open in Hyesan, in north-central North Korea, and in Wonsan, a port-city-on the eastern coast. Aid officials chose those two cities because of Hyesan’s remote, mountainous environs - which make food delivery difficult - and because of Wonsan’s status as a major port. “It’s useful to have people there to help handle and monitor the commodities as they enter the country,” the official said.

The WFP already has four offices up and running in Chongjin, Hamhung, Sunuiju, and the capital Pyongyang. The new staffing arrangements paved the way for this latest US contribution, aimed at alleviating widespread shortages caused by flooding, drought, and a moribund socialist economy. Those donations have drawn sharp criticism, however, from members of the Republican-run Congress, who fear North Korea may be diverting food aid from its intended civilian recipients to the military. US officials say the current food situation in North Korea is difficult but not dire, as previous aid shipments and a local crop-harvested, in October and November have made a difference. They also insist the aid is subject to adequate monitoring and say that more emergency assistance is needed. “Without substantial additional food aid, they will be back to where they were,” said one US official.

The new contribution comes despite a strict 48-year-old embargo on any US trade with North Korea, imposed at the outbreak of the 1950-53 Korean War. US officials want to lure North Korea out of its international isolation and to ensure it never grows so hungry that it resorts to desperate moves that would endanger the 37,000 US troops in the South.

In February 1998, a survey by the ‘Korean Buddhist Sharing Movement’, an organization that was on the ground both inside and outside very early on and is known for the quality of its networks and the reliability of its information, was released. At the same time, Jasper Becker, a journalist, and author of a book on the famine in China during the Mao Ze Dong regime, also released a report on the famine in North Korea, that was an extract of a book5 he had just published in France. Both provided accounts of North Korean refugees in China that had fled the famine in their country. MSF Hong Kong executive director questioned his MSF colleagues about a possible MSF assessment on the border or in the North Korean hospitals where the organization was working. Tony Hall, US Congressmen, who was lobbying for an increase of the US aid to North Korea, requested some support from MSF USA.

DOCUMENT

Fax from Alain Guilloux, MSF Hong Kong Executive Director to MSF Belgium, MSF France, MSF Holland, and MSF UK executive directors, MSF USA programme officer and UN liaison, MSF international communication coordinator, 11 February, 1998 (in English).

Extract:

Please find herewith the latest from South China Morning (front page). For your information Jasper Becker is the author of ‘Hungry Ghosts’, an investigation of the famine in China in the ‘Great Leap Forward’ years o. The 2 million-famine toll figure appeared in a World Vision report based on their own retrospective mortality survey among North Korean refugees in China. Has MSF carried out any similar survey in the area? Any hint of a manipulation by Chinese authorities to keep aid coming and North Korea afloat? Do we have any figures on hospitals’ activity in the provinces where we currently work?

DOCUMENT

“Famine Refugee Tells of Mass Destitution and Death in North Korea,” by Jasper Becker, on the North Korean Border The South China Morning Post, 11 February, 1998 (in English).

Extract:

Robbed, beaten, starving and in rags, Kim Aesang crept past the border patrols and, one moonlit night, walked across the frozen Yalu River to seek sanctuary in China. In the small border town of Changbaishan, the 32-year-old wandered around the backstreets knocking on doors, begging for food and shelter. Moved by her plight, ethnic Korean Chinese family took her in. Her story is similar to those of thousands of others flooding into China to escape the famine which, according to reports, has so far claimed at least two million lives. Ms Kim left her two children, aged five and seven, with their grandfather in Hamhung, a major industrial city on the east coast, with two kilograms of copper she hoped to trade and buy food to feed her family.

Barter trade with China in copper, timber, gold ore residue, machine parts stripped from shutdown factories has left the North Korean border town of Hyesan far better off than almost anywhere else in the Stalinist state save for Pyongyang. Ms Kim’s shoe factory closed down long ago and her husband disappeared into the countryside to work for food. With no work herself, she had no access to food. “At Spring Festival, we were issued five days’ ration of grain. Before that, we had nothing for two years,” she said. “I heard there was food from America but the cadres take all of it and when they have eaten their fill we just get the leftovers.”

At Hamhung’s railway station Ms Kim and many others waited for days for a train. Each morning, railway staff dragged away 20 corpses, so many in fact that they no longer bother to register the identity of the victims. Indeed, many had swapped their documents for food long ago. When finally a train left, it was crammed full and took three days to travel the 480 kilometres to Hyesan, the border town, due to frequent power blackouts. On the train railway guards seized her food and beat her because she had no ticket or documents. When the train arrived, eight people in her carriage had starved to death. In Hyesan, she, like thousands of other migrants, bedded down in the railway station and other public spaces, hoping to sell something or cross the border. She had sores on her body from a fever she had contracted at the station and wherever she stayed, several of her neighbours would be dead by morning. Her chance of earning money by selling her copper disappeared when border guards searched her. Left with nothing but the ragged clothes she stood in, she decided to cross the river and beg for food in China.

She and a younger woman found a guide to lead them across at night. ‘He wanted to sell me but when he found out I was married, he took her and I ran away,’ she said. Chinese Korean peasants would pay for a North Korean woman as many local females left to find work elsewhere. Ms Kim wants to stay in China and, like many others, especially the young; she hopes she may find work when spring comes. Now, government restrictions make this almost impossible. ‘What should I do? If I stay what happens to my family?’ she said. In Hamhung, government propaganda promises that by the year 2003, there will be enough for everyone to eat. “They say within five years, things will be better but no one believes them. By then how many will be dead?” Ms Kim asked.

DOCUMENT

“Famine Witnessed by 472 North Korean Refugees Interviewed in China – Refugees Estimate the North Korean Death Rate to be about 29% in the Last Two Years,” North Korea Update, Congressman Tony Hall’s office, US Capitol, document forwarded by Jim Bishop, Interaction to Antoine Gérard, MSF USA Programmes Officer, 25 February, 1998 (in English).

Extract:

Famine Witnessed by 472 North Korean Refugees Interviewed in China Refugees estimate the North Korean death rate to be about 29% in the last two years.

Time: Wednesday, February 25, 1:30 p.m., 1998 Placer Place: US Capitol, HC-7. About 500 North Korean refugees interviewed in Chinese border villages estimated the death rate of 29% during the last two years of famine in North Korea. The data in the largest survey yet of North Korean refugees in China conducted by the Korean Buddhist Sharing Movement provide the most comprehensive and uncensored picture of the course of the North Korean famine to which the outside world has yet had access. Four hundred seventy-two refugee respondents provided information about their immediate family members of 2,583 including grandparents, parents, and unmarried children, 231 hometowns, and the nation. First, the survey findings include death rates by gender, age, and household since August 1995, the time North Korea was swept by the worst floods in its history. Mortality rates among children and the elderly, the primary victims of famine, are elaborated with the attributed causes for their death including epidemic disease and malnutrition.

The survey with refugee respondents also reveals the death rates of over 200 urban districts of their hometowns with 100 - 150 population. Second, the surveyed population reveals various coping mechanism North Koreans are desperately using in the third year of famine. Third, the survey findings include a graphic presentation of population movements of North Koreans at famine risk. “Despite the agricultural harvest from October 1997 and ongoing international food assistance, the North Korean famine continues to claim a large number of victims - particularly both in the tightly /controlled north province of Jagang bordered with the mountainous Chinese side and in the city of Hamhung in South Hamgyong province – though the causes and number of deaths appear to be changing,” according to Pomnhyun, a Buddhist monk who has supervised the surveys from October 1 of 1997 to January 31 this year. He has recently returned from his 11th visit to Chinese border villages with North Korean refugees.

[…] The ethnographic field interviews were administered by 23 Korean-speaking Korean Chinese associates of the Korean Buddhist Sharing Movement, a leading Buddhist NGO in South Korea. The interviews were voluntary with strict assurance of confidentiality of the respondent’s identity. Participants in the news conference will include congressional staff, officials from the U.S. government, the Hill, and the NGO community, diplomats from donor countries, think tanks, and the media. The field research findings to be disclosed in the news conference are supported and endorsed by the leading South Korean NGOs, - which have altogether sent over 100,000 tons of food aid in the last year alone to North Korea, […]

INTERVIEW

At the time, in the United States, the general public didn’t really know what was going on in North Korea. It was very limited to the world of American NGOs, the State Department, USAID and Congress. Tony Hall was the representative of Ohio in Congress, an ex- member of the ‘Peace Corps’ in Iraq and Sudan, who campaigned for the United States to increase its aid to North Korea. In February 1998, he sent us a letter asking MSF to support his initiative calling for increased aid to Korea.

Antoine Gérard, Head of Programmes Department, MSF USA (in French).

In early March 1998, MSF started a new round of discussions with the FDRC regarding those activities to be implemented when the current MOU would cease, in July.

DOCUMENT

“First round,” Email from William Claus, MSF Belgium programme manager to MSF France and MSF Holland programme managers, 8 March, 1998 (in English).

Extract:

Hello there,

We just finished our meeting with FDRC. From the side of FDRC it was stated that:

1. The emergency phase is over and now efforts must be focused on rehabilitation. They see a role for MSF as a provider of technical assistance in the field of national production of drugs and provision of raw materials. They are still interested in the provision of drugs.

From our side we proposed:

-A reduction of the distribution programme (geogra-phically) without going in detail.

-More investment in quality and accessibility (grass roots level)

-Regarding the result of the nutritional programme = very weak attendance (less then 1%) and the fact that we may not do a nut survey will lead to a closure of this programme.

- MOH should be our counterpart.

- Access to institutions.

To be clear, there was no discussion on which type of programme MSF will do. We will see on Friday what their reaction will be. Personally I am not in favour that MSF will be involved in this type of rehabilitation programme. I think it is more in the field of AEDES or other partners. On the distribution side we will see what they will propose.

From 10-20 March, 1998, Philippe Biberson, MSF France President and Pierre Salignon, MSF France programme manager visited MSF’s programmes in North Korea. Their round of visits revealed that the teams had no visibility as to the way the assistance was used.

DOCUMENT

“Point on the North Korea Mission – Philippe Biberson, Pierre Salignon,” Minutes of MSF France Board of directors Meeting, 27 March, 1998 (in French).

Extract:

North Korea (Philippe Biberson and Pierre Salignon)

A surreal country; Philippe and Pierre visited the mission in Korea. They saw three provinces in the south (where our teams are working) but not the province in the north. They were staggered by what they saw. The country is totally different to any other, hosting the most closed off regime in the world. When we arrived in North Korea, the first thing we had to do was pay allegiance to Kim II Sung, putting flowers in front of his statue! There are frequent power cuts in the capital. We were there during an ‘alert week’. This involves a period of general mobilisation when faced with the threat of war, exercises in evacuating children from towns, soldiers with camouflaged nets on their backs, camouflaged cows and cars… It all seems ridiculous, childish and pathetic, but it also shows how far the population bows to the Nation’s command. The entire country was mobilised by radio-transmitted commands. People’s lives are completely riddled with propaganda and orders, with no information from the outside. They have no perspective on what’s going on, and a climate of paranoia and observation reigns. Things are so shut off that people are disconnected from reality.

We came away with some nightmarish human and ecological images that in some ways remind us of the Khmers Rouges in Cambodia. It’s a strong system, and it can survive a long time as it is; 30 million people on a land that’s been ‘razed to the ground’, clinically cleaned, without a blade of grass. A severe climate: harsh winters, excessively hot summers and three years of natural disasters, floods (destroying harvests, land slides, etc.), drought… We can’t see how the population – with no room for manoeuvre, living in extremely fragile conditions – can have any reserves. There’s nothing to eat, no markets, no shops, no money. 80% of the population lives off distributions (food, clothes, etc.) and we saw how easily this distribution can be transformed into rationing.

In an effort to increase agricultural production, land has been cleared contrary to all common sense, provoking a real ecological disaster. They’re now planting thousands of trees, but they’ve been taken from other provinces with just as little thought. All sectors of the economy are affected and we have the impression of being in a country that’s ground to a halt. Everything’s done by hand. There’s no more machines, no more fuel. The metro and trams in town are often broken down and masses of people move around by foot.

Same Old Story

Jean-Luc and Serge said that we’ve known about this set up for the last 20 years, and they’re surprised that Philippe and Pierre are so amazed. It’s the last of its kind…

The MSF mission

MSF has run several missions in North Korea: in 1995, in 1996 (seed distribution) and in 1997. In July 1997, negotiations with the authorities led to a memorandum being drawn up for the supply of medicines in three provinces around Pyongyang (programme costing 3 million ECUs). MSF has been working in the field for 7/8 months now. The team has passed from 8 expatriates to 13. In January, MSF began working in an additional province in the north. Our activities mainly consist of distributing medicines, opening nutritional centres, and training medical personnel in the use of medicines.

MSF is one of the first organisations to have penetrated North Korea, but there are now some 60/70 expatriates (who don’t all have access to the areas outside the capital): those present include MSF, MDM, the Federation of the Red Cross, United Nations agencies and various other organisations such as Oxfam, Handicap International Belgium, etc. Around another 10 NGOs and United Nations agencies are due to start up.

We have the general impression of a serious shortage of food and medicines in the country. The drop in production undoubtedly started in the early ‘90s and has been aggravated by the recent natural disasters. The malnutrition seems chronic but there’s no way of carrying out unrestricted evaluations of the situation. Visits are organised, we are shown what they want us to see and only sometimes what we actually want to see. The situation varies according to geographic location and the category of the people concerned. The authorities restrict us to a planned, global approach, which according to them is adequate to deal with the problem. One NGO per province, such and such a quantity per facility multiplied by the number of facilities, that’s the essence of our ‘contract’. It’s the ‘entry ticket’ to the country. MSF’s activities cover a population of 7 million people, some twenty hospitals and more than a hundred health facilities. The work is thankless: it amounts to checking that the medicines arrive at their destination and noting on lists how many children have received milk. The motivated personnel in the MSF teams are subjected to unacceptable working conditions.

We cannot work correctly. Nothing other than superficial supervision is possible. Our work is reduced to distribution (even if it is medical and nutritional) and the teams are not satisfied with this kind of intervention. In terms of collecting information, we don’t know what is and isn’t reliable. We carry out clinical work on paper, we can’t give any advice, and only a little medical discussion is allowed. There’s no follow up possible, just a quick glimpse of different situations. When we see a child, for example, we don’t know his history, where he comes from, and it’s practically impossible to see him again. They choose the children they show us, who appear and disappear. We’re not sure we know all the facilities. The team has tried to focus on a few in particular, but the size of the programmes doesn’t really make it possible. These working conditions are imposed by the authorities and accepted by us. The situation has become even more complicated since we took on an additional province. Everything’s oversized.

Conclusions

1) There are differences between what we see via the access we have and the accounts collected from refugees on the Chinese border. This mystery needs solving: generalised fragile situation or big-scale human catastrophe?

2) Whilst the food shortage seems incontestable, it should be placed in a context of general economic collapse. The natural disaster has just made things worse.

3) It’s impossible to say if the aid provided by MSF saves lives, how many or where. Aid is openly perceived as a “support system” for avoiding the most serious problems.

In practise, we’re incapable of forming a clear definition of the needs. Yet, without evaluation, it’s impossible to fix objectives, modify our activities, etc. We don’t know what impact our work has on patients’ health. Whatever the case, it’s not proportional to the amount of money being spent. It’s costing too much and we can’t even be sure that this way of proceeding doesn’t harm the population. Philippe and Pierre didn’t see any famine, but no one can move around to check and we readily believe that in certain areas the situation must be really serious (e.g. gulag, re-education camps, closed off areas, etc.). Milk and medicines are useful because there aren’t any in the country. There’s no diversion, but rather storage in anticipation of harder times. This situation transforms MSF’s doctors into policemen, responsible for checking that the medicines are used properly. We’ve got ourselves into a role that’s not for us. The problem’s structural and requires other solutions. Donors are using us, because they want to be present, even if the work they’re paying for is of little use.

The problem of quality: MSF carries out distributions over 4 provinces and in masses of facilities, therefore multiplying the errors by ten. We’re overwhelmed by the volume of orders and we’re supplying bad quality material on a wide-scale basis. It’s serious that MSF is making this kind of error nowadays. We told the teams, the people around us and the authorities exactly what we thought. Our contract runs up to July, and we will not continue working like this beyond this date. Once this was said, we got locked into a dead-end dialogue. The officials responded by saying that they were happy with our work and wished to see us continuing in the same way, with the same volume. They pointed out to us that North Korea is a socialist regime, so there are no rich and poor, everyone is treated in the same way, and if we’ve seen some differences, they are only due to disruptions in distributions caused by transportation problems and imbalances in international aid.

It’s our responsibility to hold firm with the European Community donors. Even if there is no acute famine at the moment (this is not a statement), medicines and food are needed, but this isn’t the work of an NGO. Political agreements are required, addressing structural, economic and political problems. For example, re-starting the production and importation of basic materials, re-planting forests, installing drainage etc.

INTERVIEW

I went with Pierre in spring 1998. We’d started receiving witness accounts from refugees, we’d crosschecked our information, and we’d taken up contacts with experts on Korea who explained to us how the regime worked. François Jean was beginning to have explanations for us on the way things were organised, collecting information on the regime. Eric Goemaere had been there shortly before us; he’d brought back some film and given a press conference in Hong Kong. And that’s when we started feeling uneasy about things, particularly with our Belgian and Dutch partners. Marie-Rose, the Head of Mission, was more inclined to communicate with Brussels than us. Pierre was saying: ‘We’re an active part of this mission, but I feel more and more uncomfortable about it.’ But he was very involved due to his role as Programme Manager. I was new to it all, open-minded. I felt curiosity more than anything else.

The teams were waiting for us without enthusiasm, particularly Marie-Rose: ‘Why are they coming, these French – they’re going to do another “I accuse” in the Libération6.’ We received a rather frosty welcome, the atmosphere was strained, but Pierre and I did what had to be done. We listened, we asked questions; we wanted to know about everything, however scandalous our discoveries were. It was an extraordinary experience; we were really pleased to be there, with the teams. We led them to start asking questions during our ten days visit. We told them they’d been courageous, that their lives weren’t much fun, that they’d been smart in managing to visit just about everywhere ,but that their mission was unacceptable. At the beginning, our questioning was blocked by their claims that things were getting better all the time, a little more humanitarian space was opening every day: ‘Don’t you see, we managed to return to such and such a place, it’s amazing, after two weeks, with an authorisation that was finally given to us in just two days.’

At the beginning, all the discussions focused on how hard life was for the teams, but there was no political analysis at all. In Wongjing, the team had been assigned to a residence in a kind of enormous, empty hotel. The team complained about how painful the work was, how cold they were, the lack of sleep, the lack of electricity, water shortages, what water there was being frozen, the lack of food, etc. We needed a bit of time to help them realise that this was not just an issue of material conditions, but political conditions, that they were being kept in custody, that the hotel staff was their involuntary jailors, that no one had anything to eat in this town but this was being hidden from them, and that if they were forbidden to go out, it was to prevent them from realising how serious the situation really was. We tried to develop their political analysis so they could accept that despite the progress MSF had made, there was nonetheless a problem. The problem being that we were blindly dumping millions of dollars into the country, and we carried responsibility for this money. Secondly, we weren’t sure that this money was reaching the people we were trying to help. We managed to get them to recognise this: ‘It’s true, we run around like headless chickens, we don’t visit the same hospital more than once a month, sometimes it’s every 45 days. It just takes one small thing, a puncture, or the car being serviced, and we’re running two days late. Which immediately becomes a week and everything’s pushed back. When we go somewhere, there’s a ritual: we arrive, it’s all smiles. As it’s cold, we go to a heated room. There are cigarettes on the table, some tea, a few nibbles. We ask if the delivery arrived safely? ‘Yes, it arrived, here’s the list.’ We look at two or three registers containing handwritten lists. And when we ask for something, someone gets up, goes out, finds it and comes back. Then we do a rapid tour of the pharmacy. We meet someone who’s very polite, very clean and who shows us the medicines. We ask to see the main stock; we go down into a frozen cellar where we use an electric torch to check that the boxes are really there. Then we ask to see the children. We see 3 children in beds etc… And then there’s a type of small banquet because it’s already 11h/12h and we have to eat. They feed us even when we’re not hungry. It’s good; we can see that they’ve made an effort to season it for us. And then we do three bows and leave. We take to the road again, either to visit another facility or to go home. We realise that we’ve done nothing. We’ve drawn up lists; we’ve carried out visits to check that the lists are ticked off, etc… We’ve done nothing, it’s really frustrating.’

Our discussions with the teams helped them realise that they weren’t just frustrated with their work. We said: ‘You’re the playthings of people who are smarter than you, who do whatever’s necessary to give you the impression that things are opening up a little.’ [...] By the time we left we had the impression that they saw things more clearly. We introduced them to the idea that they were perhaps contributing to the massive, planned destruction of a part of the population considered by the regime as useless, possibly harmful to the country’s stability. Over and above the capacity of the regime in terms of resources to save these people, we were participating in the organised desertion of entire sections of the population, which we estimated at 10, 15, and 20%.

Dr. Philippe Biberson, President MSF France (in French).

INTERVIEW

For me, the event that really made me realise what was going on was my visit with Philippe, how it went, what we saw and what we didn’t see; the travel by car, the furtive images, the feeling of being in a box, being listened to and watched. We were careful what we said in our rooms and during the evening banquets we were invited to. A sort of paranoia prevailed. We heard the sounds of military exercises at night and in the mornings, but we weren’t allowed to leave the hotel, we couldn’t go out and see them. There were the weird monuments all over the place, dedicated to the glory of the great leader. There were the visits to the hospitals during which we asked ourselves what was going on. We came and went; one day there were children, the next day there weren’t. There was the route we took by chance with Philippe on our return to Pyongyang. At one point we caught a glimpse of a brand new building, with people working down below, and we realised it was a prison because of the watchtower with men on guard duty. In the car, the guide and interpreter were really uncomfortable. So we said to them: ‘There are prisons in France too, you know.’ And they replied, ‘Yes, you’re right. It’s a prison.’

Pierre Salignon, MSF France Programme manager, from October 1997 on, then MSF France Executive Director from January 2004 on

At the end of their visit, the MSF France president and the programme manager warned the authorities that MSF would not continue its work on existing terms after the end of the ongoing MoU. They were convinced that MSF could not spend such a huge amount of money in a programme when it was not able to assess the situation or monitor the allocation of this aid to the most vulnerable. For their part, some members of the MSF North Korea team remained convinced that step by step they would be able to improve their access to the most vulnerable people. Other executives within the MSF movement shared this opinion. A few days after the departure of the French executive team, Pim de Graaf, the Director of Operations of MSF Holland also visited the North Korea programme. Several incidents made him think that the North Korean authorities manipulated the teams.

DOCUMENT

“Just a Few Words before Leaving, from Philippe,” Message from Philippe Biberson, MSF France to the MSF Team in North Korea, 17 March 1998 (in French).

Extract:

Dear all,

Thank you very much for this great moment we spent together. My thanks go especially to MM Lee, Pak, Hong and the others who have made my stay a very interesting experience. It has been a real pleasure to meet you individually and I have full confidence in the team you have built. Thanks Marie-Rose, I know our coming was expected with mixed feelings of hope and discomfort due to the international mess as it is. You have a difficult task here and I’m sure you are up to it. I’ll give you a few notes before leaving; I know I’ll be very busy back in Europe. If I can I’ll try to give you a more complete feedback. Sorry for being too synthetic.

1) At this time, from what we can see, there is no longer any nutritional emergency. Some areas, some populations remain in a more precarious condition but this doesn’t differ a lot from many other countries facing economic or development difficulties. The present equilibrium is dependant on:

- Continuing international food aid

- Next harvests

- Improvement of food production (irrigation, drainage, erosion, fertilisers...)

In case of a new emergency MSF should be able to react again. The nutritional problems of the last years have benefited from our action but the problems we see now can no longer be addressed the same way.

2) At this time there is no medical emergency in this country. No epidemic, no acute crisis in terms of ‘public health’ (except may be at the level of infant and child nutrition). Entering in this country for the food emergency, we were presented with a real problem of shortage of essential drugs in the hospitals. Long-term declining productivity plus three years of disasters have led this sector to a stand still. We decided to respond to this problem by a general and standardized distribution programme: July 97-July 98. We have done our best thanks to the teams but due to many problems (programme definition and local constraints) we have not been up to our medical ethics. These drugs and equipment have been useful but we cannot evaluate the benefits for the populations at the level required by the enormous amount of money involved.

My opinion is that MSF must not continue on this type of programme once we have satisfied the present contract (July 98). MSF must not extend another 6 months/5 million ECU type of programme. As for the general food availability, the drugs availability should be addressed by international, multi- or bilateral aid. Reinforcing local production, imports and distribution capacities of this country. Emergency supply of medical items is not appropriate for medium term solution. It is very expensive creating dependence and it is disrupting national channels of repartition. MSF should play a role in fostering this approach rather than the present. Due to the wideness of this distribution programme, MSF doctors are unable to do much more than investigative control on repartition and utilization. MSF has to inform and discuss with all partners from now on to make this opinion discussed widely. For the 4 months lasting and in the 4 provinces we should strive to improve the execution of the present programme with the experiences we gained in the past months and identify zones and/or populations where to concentrate our action. Concentrate on people rather than on structures. We should make proposals to the FDRC as often as we come across specific situations.

If the answer is “NO,” just do as much and as wide as you are doing now (FDRC), then we have to say no as well. Be it on a temporary basis, but they also need a clear position from us. If the answer is yes, then we have to prepare for many difficulties but then the challenge is up. As MSF, we have to show our compassion, our competence and our capacity to save lives, ordinary lives. The Koreans are quite open, frank and direct, let’s be the same. We have nothing to loose. In one case or the other, it will necessitate a lot of frankness between all MSF chains of decision. Good and strong decisions are required. They cannot be taken if there is no factual, fluid information or if there is a climate of lies or dissimulation. I will do my best to have the HQ help you define clearer objectives for the future and be of a real support to the project. Thanks again for your ‘accueil’, [welcome] and good luck.

Avec mon amitié, Philippe. 17/03/98.

DOCUMENT

“A few remarks on Philippe Biberson’s Visit (in haste),” Message from Marie-Rose Pecchio, Coordinator North Korea, March 1998 (in French).

Extract:

SOME REMARKS ON THE VISIT OF PH. BIBERSON (in haste)

-Fixed ideas on the project before seeing anything at all: too expensive, not MSF’s job, not enough proximity to the populations

-For MSF F, the decision had already been taken: the number of kits was reduced for ending the programme in July and not a day over. Yet I believe that no decision has been taken on an international level yet??

-For them, it’s clear; they’re pulling out on the 1/8/98.

-Didn’t take the time to spend time with me and hear my opinion about the project.

Didn’t take the time to speak with Dominique and Brigitte who have been here since the project started and who could have explained where we’ve come from and how far we’ve got.

Conveniently forgot that it was MSF F who started this project, with a distribution of medicines to give us an idea of the country’s situation. Let’s just say that the ends justify the means. The means = distribution. The end = knowing the state of health care in the country. Still no reliable results after 6 months, so we’re throwing in the towel.

-We’re starting to have good contacts with medical personnel in the field, we’ve built up a climate of confidence, and we must not drop it now because it’s the departure point for another approach.

-We have access to orphanages and the TFCs give us contact with the most vulnerable population, so we’re already conforming to one of his criteria.

-The contacts we’ve established with the medical personnel should also be differentiated from the distribution.

-His idea of being close to the vulnerable population is nothing new: It’s already in William’s report after his visit in November ’97.

-No objection to his proposition, it’s the way he made it that bothers me: really quickly, with such immediacy riding roughshod over the context and 50 years of communism.

-Not once did we consider leaving something behind after our departure: we distribute in 4 provinces. If we stop everything from one day to the next ??? We should plan a smooth exit with a handover to someone or something else. 4 months is a bit tight for setting something like this up.

-If MSF does not distribute medicines (F and H opinion), then why did we start?

-All his propositions are based on a big idea; it’s the field that has to make things concrete. I proposed to concentrate on one particular district for a week or 15 days, so we can go into things more in depth: training, data follow up (morbidity, consummation of medicines, prescriptions), he didn’t even consider it. We should concentrate on people, not structures, he said.

-I think that when headquarters comes to the field, it’s to talk about the future, but also to help with the current project. Which was far from being the case.

-I don’t think we can go fast in this country, like we do in other MSF projects. We have to leave behind the classic MSF approach here (rapidity, immediate results, etc.), but I don’t think he’s capable of this. The tried and tested MSF party line, and nothing else. Too bad for those who want to try something different. They’re not real MSF.

-A lot of doubts arose on past coordination without a medical coordinator, which refutes all the work of Jacques and Dominique.

-He said that he had come to listen: he did 80% of the talking. I felt really really uneasy during the entire visit of the Great Leader who holds the MSF Truth and above all who arrived with pre-conceived ideas on the project. With people like this, I don’t even try and fight my corner; he never listens, whatever I say. He’s the one who KNOWS and it’s over my head, he says. I really tried at first, but I soon realised it wasn’t worth it.

Marie-Rose.

DOCUMENT

Message from Mario Goethals, Director of Operations MSF Belgium, to William Claus, MSF Belgium programme manager and Eric Goemaere, Executive Director, 25 March, 1998 (in French).

Extract:

I’ve read the two messages – Biberson-Pechio – and I think there’s a real problem. It would be good – for Biberson’s ego – to have him read Marie-Rose’s response
/remarks and realise how he was perceived in the field. I hope that Philippe’s report will go a bit further into detail than the ‘summary’ sheet because as Marie-Rose says, it’s far too general. I think that we all – the combined MSF sections – have the same objective, but the strategies for reaching it are sometimes radically opposed (rapidity <-> patience, massive assistance <-> political negotiation, work <-> criticise). But nonetheless I’m convinced that we, in Belgium, should integrate a more critical and political outlook, amongst others, without reducing our assistance.

INTERVIEW

There were debates within the North Korean team at the time. The different members were uneasy. They didn’t hide their doubts. Institutionally speaking, the visit of MSF France’s president and a programme manager to a team coordinated by MSF Belgium was welcomed, but at the same time the field wondered what we were up to: have they come to close the project? And we did indeed come back with the idea of closing. And, then there were the dynamics in the field at the time. If we close, if we drop these people, we’re responsible. This is the argument that’ll be used against MSF by those who’ll say we’re leaving and slamming the door, we’re leaving people dying in their thousands, we’re responsible. But we were just a foil. Which is what I said in my visit report: ‘Watch out, don’t under-estimate what’s been achieved over the last six months, take an objective look at the teams’ difficulties.’

I remember that I put a lot of time and energy into writing this report. Why? Because for MSF, given the questions being raised, we had to try and set out the different elements pointing to an end to distributions. We were in the phase: ‘Shouldn’t we try stream-lining things first?’ Then we would say that conditions required renegotiation. And if there was no negotiation, withdrawal should be an option. All whilst remaining polite and putting a date for June/July.

Pierre Salignon, MSF France programme manager, from October 1997 on, then MSF France Executive Director from January 2004 on

INTERVIEW

During out stay, we gave the people around us indications of our astonishment and unease when confronted with different situations. I remember conversations in the car, on leaving the hospital, conversations in French in front of people who understood French perfectly – even if they were interpreting English into Korean – conversations that were set up with Marie-Rose or Pierre: ‘How would you cope with being a doctor and not being able to see a patient more than twice in a row? Personally I find this a really difficult situation to work in …’ So we’d already “worked” the people watching over us, letting them know of our unease, of MSF’s unease, by saying, ‘These working conditions are totally unsatisfactory, MSF can’t do its work properly.’

And then when we met the Flood Disaster Unit authorities – who were intelligent people, negotiating with MSF and the outside world, but who weren’t really the decision makers – we started saying to them: ‘We’ve had a really interesting time but our working conditions are becoming increasingly hard to accept, we’re not used to working like this, we’re an independent organisation, we have a moral obligation of ensuring the impact of what we’re doing with regards to our donors and the working conditions imposed on us here mean we can’t be sure of anything. And then, we would like to use what’s left of our time before renewing our contract - we signed it for one year – to examine the possibilities of working completely differently, in other words being fixed in one place, providing care for children, and not just scattering aid around as we do at the moment.’ They looked astonished, they discussed it between them etc… and before the meeting ended, they said to us: ‘You can’t just leave like that, when are you leaving exactly, we have to meet again in two days to discuss what you’ve just said.’ And before leaving we had a meeting with the same group plus some extra people - they had obviously reported what was going on to their superiors - it was a much more political discussion. We said to them: ‘You can take it or leave it. We’ll respect the current contract but you should know that we’re totally unsatisfied with the way our aid is being delivered, because we have no guarantee that it’s really reaching the people. We wonder what’s going on when we see certain children in a really bad state in hospitals that appear to work well. It makes us uncomfortable. Where are these children from? We would like permission to work in certain facilities that we’ve identified, but where - here, there, etc.?’

Marie-Rose thought that I’d already taken a decision and was ready to impose it on her. She probably said something along the lines of: ‘I hope you’re not going to doing anything stupid, because I have to stay here, dealing with the fall out whist you’re safe and sound in Paris.’ I must have replied to her: ‘I’ll write up a report of how I see things before I leave. We’ve spent ten days together, we’ve got on fine, we’ve worked well together and I think we’ve made a lot of progress. Now I think it’s nonetheless our responsibility to get things sorted out. You have to get used to this idea. I don’t want to be sensationalist, but I don’t think we’re reaching the standards, the principles that MSF wants to abide by. We’re completely off-track, you say it yourself.’ She said, ‘Yes yes I agree.’ So I replied: ‘So we have to do something about it.’ In fact, she was scared of getting her fingers tapped by Brussels or Amsterdam. ‘We’re an international mission etc.’ I said to her: ’I’ll deal with that, I’m going to speak to Eric [Goemaere, Executive Director of MSF Belgium] when I get back.’ I understand that Marie-Rose felt sidelined, disturbed by our visit, by what we had to say. Maybe too much remained unsaid, both on her side and mine.

Dr. Philippe Biberson, President MSF France (in French).

INTERVIEW

The visits were organized and manipulated from A to Z. You had to provide for a weekly visit programme. On Monday, we would go there to that hospital, on Tuesday there and so on. In general, that would be accepted but in some cases they would say: ‘Your Wednesday programme cannot take place.’ They wouldn’t give a reason. Another case: They had agreed, but upon arrival at the hospital, their hospital director or the party boss, or I don’t know who, would say: ‘We have a disaster exercise so you cannot visit us because today we have to evacuate all the patients from the hospital as an exercise. So please go home. So it happened that people would be in a car for a couple of hours, arrive at the hospital and then have to go back home without any information. Also, during the visits, you could see patients being treated - I saw a few consultations myself - the dentist - the children in the children’s’ ward—but you were never sure whether those were real patients.

There are a few examples—concrete proofs of manipulations. I remember one report that a MSF team had visited a hospital and seen a ward with children and women—the mothers of the children. Then they left. But because someone had forgotten something at the hospital, after ? an hour or ? of an hour, they would return to the hospital unexpectedly and then they saw those mothers and children on their way home from the hospital. So obviously, they had been there to show to the MSF people that the children were hospitalized and their mothers were there. Why they would want to give this impression to MSF, I don’t know. But it was a proof of manipulation. So there were a few more of those incidents that gave us proof to confirm our suspicions effectively.

Pim de Graaf, MSF Holland Executive Director (in English).

At the same time, during the two last weeks of March 1998, a team led by the coordinator of MSF France in China collected testimonies of refugees with the help of local underground aid workers and activists. They were giving assistance to refugees in northeastern China provinces (Yanbian Autonomous District, Jilin, Liaoning and Heilongjiang Provinces) near the North Korean border.

DOCUMENT

“Exploratory Mission, Liaoning and Jilin provinces,” March/April 1998, Marcel Roux, Marine Buissonnière, Report 7 April, 1998 (in French).

Extract:

[Relief organisation operating on the border]:

We’d been running a little support network for North Korea refugees in the Changbaishan region since 1996. We’d receive the refugees as they came out of North Korea, mainly in the border towns of Ji’an, Lanjiang and Changbai. Once in the network, the refugees were repatriated to a rear front, in an area further away from the border, where they were more secure. We had outposts in Mukekou, Liuhe, Tonghua, Baishan, SongjiangHe and Erdoubaihe, to name the most important. The refugees were placed in families supporting our network, or in premises rented specifically for them. Once they had been treated, fed and put back on their feet, we helped them find work in a big town where they buried themselves in the Korean community: Yan, Shanyang, Dalian, Quingdao… Sometimes we could even buy a Hukou for around 8000 Rmb. We tried to find foster families for those too young to work, which wasn’t always easy. They all arrived with scabies and various skin diseases. Which is why the previous year we had to keep 30 young people aged between 12 and 18 in our own premises.

We estimated that some 50,000 to 70,000 people had crossed the border since 1996. We managed to support a few hundred of these via the services offered by our network. The number of refugees increased dramatically during the summer of 1997, with more and more children amongst them. The increasing numbers generated a lot of hostility from the local Chinese population, who stopped pitying them. No one opens their door to a North Korean nowadays. Especially when there’s a fine of between 3000 and 6000 Rmb for anyone caught helping a refugee. A few weeks ago, in Baishan, a couple took in a refugee for the night and was murdered by the very person it was trying to help. There was more and more theft: we can’t really blame people for shutting their doors. We had to deal with numerous problems of theft last year when all the children were in our premises: everything disappeared!

Last year, at the peak of the refugee flow, a hundred or so North Koreans who’d been rounded up by the Chinese authorities were taken to a camp in Heilongjian (August ’97). After a few weeks and some threatening noises from Pyongyang, all the refugees were sent back to North Korea. Some refugees were denounced by the Chinese, who want to earn the denunciation bonus. Others just get caught by the Chinese police or in the nets of North Korean agents infiltrated into China. But apparently the agents only pick up those refugees involved in important commercial activity, or who were in the military or occupied posts of responsibility before defecting. In September 1997, a couple was arrested in Jinan. The North Korean agents caught them, passed a bit through their cheeks and led them back to Korea like beasts. In Tunen and Changbai, they have a ring put through their nose and are pulled along by a rope. And all this on Chinese territory.

“I’m 46 years old. I was born in North Korea and I fled the country with my parents when I was 9. The rest of my family all lives on the other side, in the area of ZhonJiang. I’ve made several return journeys to my native village this year, taking cereals, essential medicines, milk for the children and clothes. This kind of distribution, extending beyond the family framework, is not allowed by the Chinese. So I cross the border with a commercial licence, in a truck. When I return to China, I buy a symbolic cargo of wood to balance out the exchange, and everything goes fine.”

The last time I went was in August 1997. The situation was critical. I saw children with big bellies, big heads and discoloured hair. I saw the bodies of children and old people in the streets. I saw people gathered around train stations, where the doors remained firmly shut. It was awful. There was no food, no medicines, and no fertiliser for cultivating the land, no tools for working. Families were exploding: people were splitting up; it was each one for himself. In Jiang Ji, a woman ate her two-year-old child to avoid dying of hunger. I don’t know where the international aid is going, but one thing’s for sure; it isn’t arriving in this region.

Over the last few weeks I’ve received more and more letters asking for help. They all tell me that they can’t find any more food that the situation’s getting worse by the day. But we’re reached our limits. We can’t do more. People know me and my telephone number circulates amongst people planning to try their luck in China. Once they’re over the border, they contact me for help. We’re overwhelmed. I don’t know what to do anymore.”

Man, Hui Shan (Hyesan), 34 years old

“I come from the town of Hui Shan, just over the border from China. I got over the Sino-Korean border by crossing the Yalu, which isn’t very deep, in July ‘97. I was employed in a state-run company; I don’t have any particular qualifications. I don’t know how to do anything in particular. When my company gradually wound down its production, I found myself with no salary, no alternatives. The rations of cereal distributed by the state started to dwindle in 1991 and had disappeared altogether by 1995. We received absolutely nothing in Hui Shan for over two years, and I had nothing left to feed my wife and three children. We managed to survive for a while, for better for worse. I saw people dying of hunger around me, but it didn’t really affect me. Then my 5-year-old son died of hunger too. That changed everything (tears). My situation isn’t at all unique. It was the same everywhere, and Hui Shan, on the border, was one of the better off towns. Distributions of cereals to Yun Shan stopped more than 5 years ago!

Last June, a distribution of one kilo of rice per family came out of the blue. I asked where the rice came from. I was told: just take it and mind your own business. I thought it must have come from international aid. It was the only time it happened. Most aid goes to the army’s officer ranks and the government; it never reaches the common people. Those who have a bit of money get rich and do business; the others die of cold, hunger and disease. There were epidemics of cholera in Hui Shan. The hospitals were empty and the medicines and food were no longer free of charge. Just as the factory workers dismantled state companies and sold the metal piece by piece, the doctors sold their working tools too. Hospital medicines were sold in the market and the hospital stocks were empty. Doctors have to survive like anyone else.

More and more people were leaving their towns to head for the countryside in search of food. The train stations were packed and the dead were piling up, especially old people and children. To such an extent that the train stations in the area are now shut. Bodies in the streets are a daily sight. Violence has become endemic: those who have nothing have to steal to survive; it’s the only way to get by. Honest people die first. Since the death of our son, my wife has started up a little business on the border to survive. It’s what keeps our other two children alive. She goes inland to sell clothes from China, passed to her at the border by Chinese ethnic minorities. She sells all sorts of other stuff too.”

Man, Bei Qing (Buk Cheng), 23 years old.

“I come from the town of Bei Qing (Buk Cheng). I’m 23 years old. We’re a family of 4 children. I’ve got two brothers and a sister. Last year, the situation in the town of Bei Qing became more and more difficult. There were deaths from typhoid, cholera and then hunger, and the bodies were lying in the streets. We had nothing left to eat. The distribution of cereals in urban areas had stopped some three years before and the prices on the free markets were exorbitant. We had nothing left to sell, no revenue, no money. So we all agreed to split up, to go our separate ways. The situation’s the same in most families now. It’s each to his own. My parents couldn’t look after us any more; they didn’t even have enough for themselves. When I left, my father was already suffering from malnutrition. He was weak and thin. I think he must be dead by now. I don’t know what’s become of my brothers and sisters. Our neighbours ate their own daughter so they wouldn’t die of hunger. It’s true. I saw it.

When the cereals stopped being distributed, people started moving around. There were strict controls in the past and a valid travel pass was required to pass from one county to another. Now there are so many people travelling round the country that population movements have become uncontrollable. So I decided to leave for the town of Hui Shan, where I’d heard there was more food available due to the border trade. I took the road to the North, managing bits of the journey by bus. But the bus, which was supposed to run daily, only ran once a week and often broke down. It was packed and couldn’t take everyone who wanted to board. So I walked, like thousands of others. Bodies were lying on the roadside all the way from Bei Qing to Hui Shan. Adults, children, all ages. We saw children with big bellies and big heads, and incredibly thin people. When I arrived in Hui Shan, I decided to cross the border. I’d heard there was food on the other side. I crossed the river and knocked at peoples’ doors, who told me where I could go to find help. That’s how I found myself here. Here, Koreans look after Koreans. In our country, no one’s interested in any one any more.“

INTERVIEW

Marcel and I went up to the border for the first time in March 1998 with a South Korean friend who acted as a translator and introduced us to the network. We went all over the North Korean border, practically from Yanji to Dandong [the length of the border]. Using contacts set up by the South Korean network, we met North Korean refugees at various different points and places: some had just arrived – once we were in a house when a group arrived. It was people who had literally just crossed. Others had been there for several weeks, or even several months, and started to tell us about an apocalyptic reality, which initially left us, like others, a bit sceptical. We asked ourselves what they were talking about. We heard descriptions of people so tired that they lay down by the side of the road and stayed there, dying on the spot; we heard about children with oedemas, kwashiorkor, de-pigmentation, on top of chronic malnutrition, because they were really really small. We also heard about this system of public distribution that had stopped functioning several years ago, according to the people we met. These people dated the beginning of the famine to the early ‘90s and not to the period of flooding in the middle of ‘95, and started to describe the system to us.

These accounts shed a completely different light on what was going on inside the country, on this famous class system inside Korea. The refugees explained to us that such and such, whose grandparents had fought alongside Kim II Song, had the right to live in Pyongyang, and had access to food, and as far as possible, universities, etc. On the other hand, the people we met had been sent to the northern provinces long ago, to the mineral areas, because their grandparents were landowners or because they were on the wrong side during the Korean War. They were the first to suffer from this non-access to food resources. At the time, we also heard descriptions of public executions for people arrested for selling human flesh in the markets. ‘Cannibalism in North Korea’, an expression taken up at will by journalists, was just part of what was going on at the time. We heard about people dying by the dozen. A priest told us that one morning he went into a neighbour’s pigsty and saw 6 children frozen to death. He buried them. The population described scenes of horror.

And over and above the abandonment by the system – because they’d been abandoned by the system for a long time – they described how families were falling apart. They were obliged to separate to survive. Some decided to sell everything, including the house, share out the gains and leave in the hope of finding each other again in the future, depending on how they fared. They had the impression that they could survive better apart. There were a lot of street children at the time, and many of them on the Chinese side. They’d crossed the river. They crossed in groups to try their luck, hoping to find help because they’d heard that there was food in China, that “even the beggars eat white rice”. This phrase came up again and again. I remember a North Korean being scandalised that maize was given to cattle when Koreans hadn’t had maize to eat for so long. He told us he ate grass and tree bark to survive. All these descriptions pointed to enormous social violence, a system in decline that no longer worked. It was the time when people in North Korea were taking apart the factories they used to work in and selling the metal via markets in China. They stopped by to try and find help. We were sceptical when we first heard these accounts, because the difference between them and the news we were getting from inside the country via the teams based in North Korea was incredible. The discrepancy was so vast that we were taken aback. But as these interviews wore on, conducted with different people, coming from different provinces (North Hamgyong, Hwanghae and Chagang) and cared for by different networks, we ended up with a coherent picture.

Marine Buissonnière, administrator, MSF France in China, December 1996 to January 1999 (in French).

In late March 1998, MSF was approached by journalists and asked to react to the accounts of refugees collected by the Korean Buddhist Sharing Movement. Thus MSF Belgium initiated a plan of communication on the situation in DPRK, and MSF’s international communication coordinator started to gather information in order to prepare a press release. Eventually, considering that this communication would happen too late after the Korean Buddhist statement and that the DPRK authorities have agreed with the ‘idea’ of a nutritional survey, the field team concluded that the press release was not necessary.

DOCUMENT

“North Korea Saga,” Email from Eric Goemaere, MSF Belgium, Executive Director to William Claus, MSF Belgium programme manager, copy to Jean-Marc Biquet, MSF Belgium Deputy programme manager and Daniel De Schryver, MSF Belgium, Director of Communications, 24 March, 1998 (in English).

Extract:

William,

Hereby how I would see a plan of communication on the situation in DPRK. The objective would be: get the international community to be more pressing on the government for access and reality (and not only MSF for which a direct contact would be probably more useful).

l. MSF is present since ...with expats in 4 provinces. We have mounted XXX TFC and distributed kits to XXX health centres and hospital.

2. The situation we record until now:

-Number of malnourished children in TFC (especially the fact that it went up and now down which is a comparative measure).

-Difficulty of access to the TFC for the people (climate, distance, other barriers??).

-Lack of medicine and effect of the distributions on the number of patients (reality as far as possible).

3. Conclusion from what we see:

-On the million of deaths recorded on the other side of the border.

-On the general malnutrition (be careful: the extrapolation as made in the draft is a gross mistake of methodology ...forbidden).

-On the medical situation and frequentation of health structures.

4. General conclusion

l. The international community and MSF particularly is embarked in one of their biggest relief programmes

2. We fear that the actual strategies are maladapted and do not answer the real problems of the people.

For example: TFC are too far and access is discriminated

THIS WILL CAUSE OTHER UNNECESSARY THOUSANDS OF DEATHS, PEOPLE ARE DYING AT HOME AND WE PROBABLY CANNOT REACH THEM AT THIS STAGE

We ask:

- An unlimited access to the villages and household in the provinces where we work order to asses correctly the problem the people face and be able to answer with an adapted strategy.

- A coordinated effort of all the aid community to make an accurate diagnosis of the situation by accessing villages in all the provinces where they work and adapt strategies accordingly. We cannot accept that people are speaking on one hand about millions of death and that the international community is deploying on the other hand one of her most expensive relief operations.

DOCUMENT

“Press Release,” Email from William Claus, MSF Belgium programme manager to MSF Belgium, MSF France and MSF Holland programme managers, directors of operations, and directors of communication, 25 March, 1998 (in English).

Extract:

[RE] From: William CLAUS

Hello loves,

Yesterday I had a telephone contact with Samantha concerning the press release. We agreed that she should propose a communication strategy and a draft press release. See you.

WC

DOCUMENT

“Re: Press Release,” Email from Samantha Bolton, MSF International Communication Coordinator to MSF network, 26 March, 1998 (in English).

Extract:

From: Samantha BOLTON

MESSAGE - After talking to the field and a couple of the sections, it would seem that the aim of the communication is to put pressure on the N Korean government or to request more access to the people in the provinces so that we can conduct a scientific survey to establish how bad the malnutrition and food problems really are. This is a coherent message and we can do as much or as little as you like, but we have to work out how we want to and where.

TIMING - The Buddhist monks and their death claims, were actually made public on the 3rd of March, so there is no emergency to issue a statement to disclaim this. The Red Cross North Korea Appeal has been pushed forward from May to April, so soon North Korea will be on the agenda, and so we should try and time ourselves to just before their campaign - sometime in April (as you probably all know, they are steering clear of the call for food, as there is no control over where the food is going or how much gets through the WFP/Govt pipeline). Most of the relevant desks and directors who have been visiting the field will be back on Monday and in addition, all the press officers of the network are in a meeting until the end of the week, and won’t be back in their offices until Monday. For this reason, I suggest we leave any action planning and discussion until Monday that way we can also find out at this meeting how much N Korea is being talked about already around the world.

MEANWHILE - if the team in the field could continue to answer press questions related to the Buddhist statements as you already have and as you see fit, this is the best way to go forward until we have something more organised.

OTHER COMMENTS - re replying to the Buddhist claims on paper. By even mentioning them on our headed paper for public distribution, we are giving them credibility. We have no way of knowing how they did their research and can get into trouble on paper talking about other agencies unless they have directly attacked MSF and we need to do a ‘disclaimer’. We should focus on what we know in the field! The main problem is finding information that we can give out which gives credibility to our opinion. MSF has apparently signed some sort of agreement with the North Korean government, which stipulates that we are not allowed to give out public health/medical information. This is a rather surprising agreement for MSF to sign given our charter and given that in most places, health information is to a degree public (govts always issue stats), and if it is collected by us, then it is MSF, data, not Korean government data. This is an issue for operations and the field to sort out and communications have to work with what we are given, but we do need to be credible to communicate!

CREDIBILITY - From a purely credible medical, communications and operations point of view, we do need a minimum of information to support any statement we make, even if it has been made public before. Basic health information or malnutrition indicators are not state secrets, and it would be good if the teams could see what they think is feasible or not to give some field credibility to what we are saying. The information doesn’t have to be too much in detail (there were already some such details in the press proposal sent to me), but it must be credible. MSF needs to somehow show that we are actually seeing and working in the clinics and not just hanging out in the capital which of course we are not - otherwise it looks like we are not doing the basic job of collating and analysing basic medical data of who we see in the clinics etc. or that we are censored on our own medical data by the government! […] Look forward to your feedback and will talk to you all on Monday.

Have a good weekend.

FIELD – please advise how the talks with the North Korean authorities went. Also, don’t worry, comm will always send you everything for comment before anything goes out! We need you more than anyone else to comment! Kind regards and have a good weekend.

SB

DOCUMENT

“Re [2]: Press Release,” Email from MSF Pyongyang to Samantha Bolton, MSF International Communication Coordinator, 29 March, 1998 (in English).

Extract:

From MSF-Pyongyang at MSF-Brussels

Dear Samantha,

We received your message concerning the press release. All the team agrees with your remarks and comments.

1. About the information: we don’t collect the data. They are giving it to us by the health responsible of the counties. In NK, the data is secret of state and a very touchy point. If this point is in the MoU, I think they asked for it.

2. Concerning the meeting with the authorities, Pim and myself: it was on Tuesday 24/3. I had another one on Friday 27/3. The main point has been the press release. Pim explained what and why. He asked for more access, it means to do a survey among the population; like that we will be able to adapt our projects according to the needs. For the FDRC, the press release is not a problem but they repeat that they have not been happy by the previous one and ‘the collapse of the health structures’. With a negative advice about the country (no free access, for example) we will scare the donors. About the nutritional survey, they accept. The way to do it has to be discussed. It has not been “NO” as previously. I spoke again during the next meeting, it was the same answer. Then, as we are a bit late to answer after the Korean Buddhist and the 2 million dead.

-The authorities agree with the idea of a nutritional survey.

We don’t think it will be necessary to do this kind of press release any more. The talks about with FDRC performed already the purpose i.e. to be allowed to do a survey.

Marie Rose

DOCUMENT

“Re [3]: Press Release,” Email from Samantha Bolton, MSF International Communication Coordinator to MSF network, 30 March, 1998 (in English).

Extract:

Dear all,

Further to the note below, plus to Pim’s comments that the message should not be that we want access (as it seems we now have it), but that eventually we want to prove or disprove whether there is or is not a ‘famine’ where we are working. Operationally it would seem that the priority is to:

1) do the nutritional survey and

2) do an analysis to see/prove where possible, if there is or is not evidence of a famine.

From a communications point of view therefore there are two possible strategies:

A) COMMUNICATE UP FRONT FROM THE START

1. Thank the N Korean Govt publicly for allowing us to finally do a nutritional survey/announce that MSF will do a nutritional survey (specifying when and where, with what purpose), thus putting indirect pressure on the authorities to make sure we get in.

2. Produce medically/nutritionally accurate report (no political conclusions/interpretations - as the facts speak for themselves). Needs to be accurate no matter what the final use will be - on/off the record etc.

3. Then give out the results to shed light on the nutritional levels in the relevant provinces

or

B) WAIT AND SEE BEFORE COMMUNICATING

1. Do the nutritional survey and collate as much data as possible.

2. Produce medically/nutritionally accurate report (no political conclusions/interpretations - as the facts speak for themselves). Needs to be accurate no matter what the final use will be - on/off the record etc.

3. Work out strategy for giving out results of the study to prove or disprove the reports of famine - taking into consideration how much access we got, how reliable the info was etc.

RECOMMENDATIONS

I would recommend that MSF go for the B option - this is because :

1) MSF wants to be able to do initial research out of the spotlight, and if it is out in the open and on the agenda people surveyed could be more reserved with the info.

2) If we announce that we are doing a survey, our professional credibility is on the line as we will then be under pressure to come out with coherent results publicly no matter what.

OTHER COMMENTS

We cannot publicly in a statement comment on the ‘reliability’ of other agencies’ data (i.e. the monks) - this would get us into legal and other “aid agency slagging matches” - terrible for our image - especially attacking. The best way to prove or disprove rumours is to produce the evidence – i.e. medical/nutritional data from the survey.

That is all for now. Look forward to your feedback. Kind regards

SB

On 1 April 1998, the French daily Libération published a three-page dossier on the situation in North Korea. One article was based on an interview of the MSF France President, Philippe Biberson. He described the difficulties encountered by the MSF teams in getting access to the most vulnerable and in monitoring the dispatch of its aid. He said that he suspected that malnourished children were shown to MSF teams in order to attract aid but that the teams had no evidence of an ongoing famine. However he pointed out that it still did not prove there was no famine. This publication gave rise to heavy reactions within the MSF network and from the MSF North Korea team who felt betrayed.

DOCUMENT

“North Korea: A Manipulated Famine,” Romain Franklin, Libération, (France), 1 April, 1998 (in French).

Extract:

Some one hundred employees of international humanitarian organisations currently live in North Korea. There were hardly any a year ago. The reason for their presence: a food shortage, or famine, the scale of which is hard to fathom. Estimations range from several hundred to one, two, or even three million deaths since 1995. This incertitude, skillfully maintained, is starting to arouse profound unease within certain NGOs, who have the impression of being manipulated. Médecins sans Frontières (MSF), present in the country since 1995, didn’t mince its words with the Libération when describing its intentions to ‘question’ its work in North Korea.

“It’s time to redefine our missions with the authorities,” explained Philippe Biberson, President of MSF, following his return from an investigative trip of one week. “Our organisation can’t do what it would like to do in North Korea,” he continued, “meaning work at a human level. Our work is useful but could be judged condescending and open to political manipulation.” MSF, whose current programme runs until August, spends nearly 30 million Francs distributing medicines. “It’s an expensive programme,” remarked the MSF President.

Since January 13, the global humanitarian assistance provided to North Korea (via the UN, NGOs and bi-lateral assistance) has cost 415 million US dollars. This aid includes the 658,000 tonnes of food sent by the World Food Programme (WFP) – the biggest operation in the world. “The food shortage is such that we have no doubts about the usefulness of our presence,” moderated Biberson. “But the constraints imposed on us are hard to accept. We can’t go to peoples’ homes, it’s forbidden. The role of our teams in the field is often reduced to policing, checking hospitals and dispensaries for diversion of our medicines. They see children in bad shape in the hospitals, but they can’t follow them up. Obviously this poses ethical problems.”

Under close surveillance

MSF, the organisation with the biggest presence in what is undoubtedly the most secret country in the world, has twelve expatriates in the field since last July. These teams, kept under close surveillance, are responsible for running some forty ‘nutritional centres’ and supplying dozens of hospitals and dispensaries in the three provinces situated around the capital, Pyongyang (Hwanghae, Kangwon and South Pyongan), and soon in a fourth, North Hangyoung, on the border with China. At the urging of UN agencies, such as the WFP, Philippe Biberson said he was incapable of drawing up a picture of the situation. In the absence of any other available term, it could be called a ‘humanitarian enigma’. “We’ve seen children with chronic malnutrition, but we can’t extrapolate for the entire infantile population,” explained the doctor. It’s obvious that the authorities want to conceal what’s going on. Like other organisations, MSF has asked to carry out a nutritional survey. This could provide a more specific overview of the situation. The request was refused, without explanation.

Staging

“During a visit to one of the hospitals, the patients had been installed in their beds just before my arrival,” he explains, “but they were actually genuinely ill…” Some staging go wrong. The statistic most often peddled by the authorities for hospitals or clinics is ‘10 to 15% of children malnourished’. But the figures get muddled at times, and don’t match the official percentages. The impossibility of NGOs working in the country forming an idea of the disaster’s size on a national scale can also be explained by the regime’s deliberate wish to conceal facts not just from visitors, but also from its population.

Does this well-kept secret hide a minor human toll, or, on the contrary, wide-scale slaughter? Are the catastrophic estimations put forward by certain NGOs – the American organisation World Vision, or South Korean’s Korean Buddhist Movement for Sharing – plausible? The former places the number of victims between one and three million. The latter extrapolates from studies carried out with 472 North Korean refugees in China and suggests a figure of three million deaths from hunger since 1995 (out of a population of some twenty two million inhabitants). Biberson’s response: “We have no medical information on the country, which is why it’s dishonest to extrapolate from studies using such small sample numbers.” Yet certain diplomats, cited anonymously by the press, are believed to consider this study one of the “most complete” carried out on the question to date.

Stimulating generosity

On the other hand, is Pyongyang exaggerating the scale of the malnutrition in an attempt to attract food aid for plugging the gaps in its economy? Is the communist regime creating this catastrophic, but non-verifiable information to stimulate generosity? That’s what MSF seems to think. “The authorities want to show us just enough to maintain the emotional involvement of the international community. We’re above all viewed as suppliers. We provide large quantities of medicines, which enter into their planned economic system. And we have the impression that what they show us in terms of malnutrition serves to attract this aid.” At the same time, Biberson does not completely exclude the possibility of a real, large-scale famine, given the sectored and hierarchical nature of the system where, even in normal times, the food rationing is differentiated according to the categories of citizens and their loyalty to the regime. “In the areas I visited, I don’t think that people were dying of hunger. But I don’t know what happened in previous years and I don’t know what’s happening in the most affected regions. It’s not impossible that certain areas are even less well off.”

Patrick McCormick, spokesman for UNICEF in Geneva, stated that the teams in the field “have seen children on the verge of dying of hunger,” often from diseases linked to malnutrition, such as diarrhoea. A study carried out by UNICEF, published in November 1997, estimated some 800,000 children (33%) under the age of 5 are malnourished. Thanks to international aid, he continued, the situation has improved slightly. For UNICEF, which can apparently confirm or deny the most alarmist reports, North Korea is well and truly in the grips of the “most wide-spread famine raging in the world today.”

DOCUMENT

“North Korea,” Email from Samantha Bolton MSF International Communication Coordinator to MSF Pyongyang, MSF programme managers, MSF presidents, MSF executive directors, MSF director of operations, MSF press officers, 1 April, 1998 (in English).

Extract:

Dear all,

As a few of your have just come back from North Korea, it would be good if we had some sort of an agreed verbal position. Doesn’t have to be fixed in stone, but just so that it is clear what line we are taking with the press. The famine questions is an ongoing issue, which will last for a while, so the basic points MSF wants to make need to be clear for the network!

BASIC VERBAL POSITION - Pierre is completing his end of trip report, but it would be useful to have a couple of paragraphs ‘guidelines’ on what our basic line is from all sections, not to be given out in writing, but just to give direction to any interviews being done either in the field or by the desks/directors. As with all countries we are working in, we have to be able to answer basic questions and give out simple public information about what we are doing, the basic problems/positive things we are facing up to etc, but it would be best if this was clear to all. Meanwhile, the teams are answering press calls to occasional calling journalists as they see fit. It is also perfectly normal and expected that when a director/president returns from a trip to North Korea (be it Eric Goemaere a couple of months ago, Biberson now or Pim), that they be contacted by their local press upon their return (as they are being) and that they be expected to answer simple questions, as they are doing. For this reason, it would make sense if the desks could clarify what our priority as a message is even if it is just in verbal interviews.

RE STATEMENTS ALREADY MADE - FYI, there have already been a variety of articles over the past few weeks, quoting MSF as having reservations about-the severity of the famine- Eric Goemaere said so in press conferences, William Claus has said so in articles and so has Biberson today in the Liberation article (which apart from the title was actually a relatively fair and neutral article), so at least on that it seems the sections agree and it is a starting point!

SUGGESTED BRIEFING LINE - In keeping with what we have already said publicly before, this could be along the lines of:

-There is no medical/nutritional proof in N Korea about how widespread or serious the famine is or is not as up until now it has been very difficult to do household surveys (access etc).

-There is a lot of political interest from outside and from within the country to prove or disprove the famine. Aid agencies and others working in the relief sector are often in the middle, and risk being manipulated.

-There are pockets of serious malnutrition e.g. in certain orphanages, but there is no proof on the rest of the country. Other data given out by other organizations cannot prove or disprove a famine as MSF has the largest medical/ nutritional presence in the country, working with the MOH, and are unable to confirm or not as yet.

OTHER COMMENTS - as long as we say that there is political pressure from all sides and that we run the risk, as do others of being manipulated, we are not being particularly controversial and are protecting ourselves in advance from being attacked at a later stage of being manipulated. It would seem that for some time now, various journalists and World Vision, etc. are saying that in any case MSF and Red Cross are manipulated, as we can’t get around the country (MSF H source). By admitting that we may be manipulated, we are being honest about the situation and not accusing anyone in particular.

RECOMMENDATIONS

As far as I can gather from your various responses, the initial idea of putting out a press release asking for access was scrapped. MSF is going to go ahead with the nutritional survey as much as possible, and then see if we can definitely confirm with MSF data or not the ‘famine’. Meanwhile, we need some sort of ongoing position as we cannot stop the press calling and as it is normal and expected to give out basic info. Maybe there could be a conference call tomorrow between the relevant desks, to clarify what our position is - with comm, so that we can inform the rest of the network.

DOCUMENT

“La Libération,” Email from Pim De Graaf, MSF Holland Director of Operations to Philippe Biberson, MSF France President, copy to MSF France and MSF Belgium programme managers, MSF international communication coordinator, 1 April, 1998 (in English).

Extract:

Bonjour Philippe,

I do not appreciate the message you spread in La Liberation for 2 reasons:

We are busy formulating a PR strategy for N Korea together with Samantha Bolton, who acts as an adviser. While we are busy, you follow your own path, why did you not communicate with the other sections or the mission in Pyongyang? The authorities in Pyongyang will receive this message as well. They might react against MSF, while at the moment there are serious negotiations going on concerning nutritional surveys to be done by MSF. This has been advocated for by Marie Rose and myself during a meeting with FDRC and has been followed up by Marie Rose since. Getting access is a matter of slow steps forward. This article may have frustrated this progress. Now we can only hope for the best and the burden is for Marie Rose who will have to explain why you say something different in La Liberation than what we have been saying to FDRC.

Pim

DOCUMENT

“Re[5] !AM! Meeting in Bxls,” Message from Pierre Salignon, MSF France Programme Manager to William Claus, MSF Belgium Programme Manager; Message from Mario Goethals, MSF Belgium, Director of Operations to MSF Belgium Programme Manager, executive director and director of communication, MSF France president, executive director, director of communication, 1 April, 1998 (in English).

Extract:

From Pierre Salignon:

[…] There is no matter in this article to create a problem. I spoke already with Mario this morning and he agreed. On the other hand, all what is written in the article (problem with the authorities for example) was said during our visit to the authorities. We really hope it will be possible to open negotiations with them in the future. Anyway, there are lots of things to discuss next week. I will send you end of this week my field visit report.

From Mario Goethals

OK my friends,

When Pierre Salignon spoke to me about this article, I hadn’t yet read it, and when Pierre told me that it didn’t pose too many problems, I said that in that case, it didn’t cause me too many problems either. Nonetheless, now I’ve read it, I think that there are actually some really serious problems, and I’m a bit lost, but perhaps someone could explain to me:

1. The aim of this ‘denunciation’, what’s our objective?

2. If there was an objective? With agreement on the objective? Perhaps even with a decision taken by headquarters to denounce? Or at least with an appropriation of this initiative by the head of mission and the desk?

3. Why an article in the Libé, why not a larger campaign if there was indeed a concerted strategy?

And I don’t find the basis of the message very coherent, because we say that we’re being manipulated, that we know we are (so who’s manipulating who?), that we’re doing programmes that we don’t really want to do but we do them anyway, that they’re costing us a lot of money but we do them anyway, that there’s no famine but we can’t prove what’s being said is false… In short, I’m not too impressed and I hope the teams in the field won’t suffer too many consequences. At the same time, I find it a shame that we haven’t had a serious discussion on our projects in North Korea yet following the visits of Philippe, Pierre and Pim. This strikes me as essential. It seems a date’s now been fixed, but can everyone come? This discussion seems more important to me than the article in the Libé. I question if we should always be assuming that field teams “have nothing to say,” it’s such a demotivating message to send out and we shouldn’t be allowing it to happen. I’m tired of all this, my friends, tired of it, because we’ve seen it all before.

Mario

DOCUMENT

“To Marie-Rose and Team,” Email from Pierre Salignon, MSF France Programme Manager to MSF Pyongyang, copy to MSF Belgium programme managers and MSF Holland director of operations, 2 April, 1998 (in English).

Extract:

I hope you are fine. After yesterday’s call from Marie rose, I would like first to come back on the interview given by Philippe to Liberation and give you some explanations. As I said during my visit, lots of journalists called us before we came to NK and wanted to know our position about the ‘so called’ famine in this country. In fact, when Philippe went back to Paris, one of them called him. Romain Franklin (Liberation) in fact already planned to write an article on NK’s situation. So Philippe answered to some of his questions and Liberation, decided to publish part of this interview yesterday with other information and their own analysis. As you can see, the interview is soft and mainly focused on “is there a famine or not in NK?” I spoke with Mario yesterday and he didn’t see any problem with what is written.

On the other hand, I understand also Marie Rose’s reaction. I agree with her on one point: you were not informed directly by us about this interview. Sorry for that. We didn’t know when Liberation was going to write the article. But it’s not a reason. Next time, I will inform William and you directly before. Anyway, I feel we must be careful not to give too much importance to this article. Philippe didn’t do a press conference and will not do it. But it’s mainly impossible after a visit in NK not to answer to questions on the current situation in this so closed country. More and more people are asking questions and as MSF is one of the biggest NGOs in the country, it’s difficult to say no we don’t want to answer. I spoke with Samantha yesterday and she agreed. This is the reason why she did a proposal some days ago we need to discuss with William and Pim. You are right to say we must be careful. You already started the negotiation with the authorities. But that’s not the reason why it’s impossible to speak about our action in North Korea and the problem we are facing. This could reinforce also our position.

Anyway, don’t hesitate to tell us what you think. But please don’t make this article an international problem between sections. It’s not the case. For your information, we plan with William and Pim to meet in Brussels next week (9th of April) to discuss the MSF programmes in NK. There are lots of points to speak about. And as I said, I really hope we will find a common approach. NK is not a country easy to deal with (you said this several times during our visit), but MSF is confronted with ethical questions we need to discuss. I’m sure we will also speak about MSF position regarding media/lobby.

DOCUMENT

“Re: North Korea,” Email from Pim De Graaf, MSF Holland Director of Operations to MSF Belgium, France and Holland North Korea network, 2 April, 1998 (in English).

Extract:

It is no option to tell the North Korean authorities that we are (or I risk to be) manipulated. They will not take that; it is the shortest way of leaving the country. At best MSF tells them that others think we are being manipulated - and they have read that in the newspapers. Probably you are aware of the senistivities that some authorities have - when we talked last week about our lack of ;free access’- our interlocutor of FDRC got extremely annoyed. We can use the term conditional access or something like that, not more. Be aware of the fact that we already told that we will spread a public message in which we would try to avoid the words ‘no free access’. You can imagine that we did not say that we would use the term manipulated. Maybe our interlocutor now feels manipulated... What is extremely important is to add to the message that, you see, we do not only ask ourselves but we are also pressed by others, so we need to have better information, so we ask to be able to do surveys, AMONGST OTHERS.

The pitfall is that we are allowed to do one or two lousy small nutritional surveys and that is the end of it. With these people you have to fight for every square inch. So, in the discussion with FDRC last week our message was that we want better information, AMONGST OTHERS by nutritional surveys. When we find other options for relevant data collection on the nutritional situation (for example longitudinal data collection) we should insist on that as well. That is why we need to send a very experienced nutritionist as soon as there is a small opening - by the way we have one available.

DOCUMENT

“Field Visit Report,” Pierre Salignon, MSF France Programme Manager, March 1998 (in English).

Extract:

Remark - The visit corresponded with nation-wide military exercises, which began on March 12th all over the country. This gave us a strong and strange feeling of “virtual war mobilisation” during all our stay in the country. Some of our field visits were cancelled at the last minute, and it was possible to see people in so called ‘military uniform’ all over the 3 provinces we visited. [...]

Comments:

First of all, it is clear that MSF has achieved a lot during the last 6 months. When MSF opened the mission almost one year ago, there were a lot of constraints to set up the mission, no liberty of movement, long procedures, no direct access to our counterparts. If we compare it to what we are doing now we have achieved already a lot and it could influence our building capacity for the future.”

-Among all NGOs and UN agencies working in the DPRK, it seems MSF has one of the best accesses to the field. Teams can ‘freely’ visit clinics. For hospitals, they need to schedule one week in advance.

-Today, some hospital staff report that since the beginning of our programme, there have been significant improvements made in several health structures and that the severe cases of malnutrition have been treated (numbers attending the hospitals are currently reducing).

Anyway, it would be a mistake to underestimate the difficulties MSF teams are facing due the dimension of our programme in North Korea.

-For most of the MSF expatriates in North Korea, the objectives and the strategy of the mission are still unclear. They don’t know if they are doing something sustainable or if they are just in North Korea for distribution of ‘drug dumping’.

-The way we work is creating major - technical/ethical - problems for MSF teams. It is impossible for the current teams to manage a vast distribution programme like this one. The time is shared between drug/milk monitoring and training. With long distances to travel, it is difficult to visit more than one county each day. This means it takes about 3-4 weeks to complete each training session and there is little time to train medical staff efficiently on meaningful topics. In fact, there is no time left (or not enough) to do clinical work. The quality of our action is not good.

-Today, teams also agreed that our nutrition programme is losing effectiveness and if numbers in the feeding centres continue to fall, it may become difficult to justify continuing this way. Steps need to be taken quickly to reach those children not being seen in our centres.

-Another big problem is delay in the distribution because of the late arrival of drugs from Europe. IDA7 cannot handle NGOs’ big orders (MSF, MDM, IFRC) and shipment to North Korea takes time. Because of the hurry, the quality of the material supplied is not always good (‘blankets for refugees’, broken surgical material such as scissors, poor quality of several items).

We must recognise that MSF is creating a dependence on curative medicine in vast areas and we don’t have yet any substitute organization for the future. I’m not sure we had a choice. But I am convinced MSF must not be involved anymore in this distribution programme in the future. The needs are too vast and appeal to another kind of long-term answer, which the international community might address with the authorities directly. As for the general food availability, the drugs availability should be addressed by international multi- or bilateral aid, reinforcing local production, imports and distribution capacities of this country. An emergency supply of medical items is not appropriate for a medium term solution. It is very expensive, creating dependence and it is disrupting national channels of repartition. That is why, in the medium term, the international community needs to give structural replies to the difficulties the health care system is facing. It is not a job for MSF, but more for UN agencies and foreign governments through bi- and multi- lateral aid (under conditions).

Conclusion:

Needless to say MSF must stop its distribution programme or, at least, must reduce drastically the number of structures/provinces it is supporting. Stopping/reducing ‘drastically’ drugs supply, doesn’t mean, MSF would leave the country: however certain conditions must exist, which do not exist today. MSF cannot continue working without being able to assess the real needs and having access to the population. Ethically, it is no longer acceptable. That is why we need to (renegotiate with the North Korean authorities the modalities of our intervention in the country. We are in a position to do so, and we must accept to take risks. After the talks we had with FDRC representatives during our visit, I am convinced that we can work in agreement with our principles:

- Need to have direct access to the population/villages/houses/institutions

- Need to organise nutritional/medical assessments

- Necessity to focus on vulnerable groups (children, orphans?), institutions (children’s centres for example)

- Necessity to develop a medical approach close to the patients. MSF is a medical organization and not a supply agency.

In case there is no space for negotiation, MSF will have to take decisions regarding its involvement in this country. We must be clear (all MSF -B/F/H- and coordination in North Korea) that our withdrawal could be an option. This should be explained again to the FDRC. Negotiations are now open and a definitive decision must be taken before June 98 (our MoU ends in July 98). Lastly, it is important to inform (in Europe/USA or on the field) all NGOs working in North Korea of our position and see if it is possible to develop a common approach in relation to the North Korean authorities. MSF must also address this issue with donors and foreign governments involved in the current North Korea crisis. For that purpose, there is a need to discuss the way the co-ordination between the sections is currently working.

DOCUMENT

“Re[3]: North Korea,” Email from MSF Pyongyang to Samantha Bolton MSF International Communication Coordinator, 4 April, 1998 (in English).

Extract:

Further for a good understanding.

MANIPULATION: “control or influence cleverly or by unfair means” (Oxford dictionary). We do not have the idea that we are manipulated in the negative sense of the word. Or course there are attempts to steer us like at any other place in the world. But we are not puppets on a string. For a better understanding it is necessary to know the system here and understand that we, and all others, and specially the local population, live and work in a country where everything is carefully orchestrated and controlled. Furthermore, it is important to understand that this is an east Asiatic country with a different mentality than we westerners are used to. Showing you the worst things is simply loosing face. Being here a longer time MSF learned how to cope with this situation, and slowly but steadily we manage to go further then any journalist can go (or new NGO’s, or directors, on indeed strict orchestrated visits). If the pace is quick enough is still a point of discussion.

Indeed we, like all others, are only tolerated in this country, if we bring in considerable amounts of goods and money and draft a MoU in accordance with those in power. At the same time we are not forced to bribe, or render goods or services to officials like in many other places in this world. Contrary to Pierre’s last remark in his annex to his report I would say that there is a quite a good coordination between the humanitarian actors. All have the same practical and ethical problems and this is something which is frequently and openly discussed. Free access, and the need for correct and independent data is high on everybody’s agenda (a suggested name for the newly formed ‘social club’ is ‘the random access club’). [...] A nutritional survey is hard to accept for the authorities because food is regarded to be a strategic i.e. military commodity. Health isn’t and therefore the co-ordination will be done by UNICEF and it will be called a health survey.

Back to food: All those bringing in food are pressed to speed up operations and to use food stocks for 6 months in one month by enlarging the target group. This would indicate that they have serious shortages. It is as well understood by all that monitoring food distribution here is shear impossible and in a way useless. Normally we have clearly defined target populations (refugees, displaced, disaster victims, etc.) Monitoring is merely locating these people and checking if they got the food. Target groups here like under five’s etc. are nation wide thus making more or less the whole population the target population. Because of the national food distribution scheme here, food allocated to a specific target will be deducted from the normal food allocated to that target. So what is monitored is a replacement of food.

DOCUMENT

“Press Release North Korea,” Email from Marie-Rose Pecchio, MSF coordinator in DPRK to MSF Belgium Programme Manager, MSF Holland director of operations, MSF France President, 7 April, 1998 (in English).

Extract:

After the press article appearing in the Libé, I think the field itself might have some remarks to make.

1. On leaving, Philippe Biberson promised to let us know if there was a press conference or something similar. It would have taken 5 or 10 minutes to type a mail or make a quick phone call to Pyongyang. No time, too expensive, or perhaps “it’s just the field, an unimportant element if ever there was one.” In a word, we feel betrayed by the lack of respect for a promise, and this on the part of one of MSF’s presidents.

2. Certain positions taken do not correspond at all with the follow up of discussions between Pierre S, Pim and the teams. The article cites MSF on several occasions. For me, MSF in Korea is F + B + H, if my memory serves me well. This article only reflects the position of MSF F, or rather, that of the Great Leader, Marxist, and Leninist of the unique MSF school of thought. I hope this point has not been completely overlooked.

3. In view of the low opinion the French have of the Korea mission, the low opinion they have of the work of people in the field – including MSF F expats – I wonder why the French are waiting until July to pull out of the country.

4. I don’t have the slightest idea how the authorities are going to react. Pim has also answered journalists’ questions. I hope that the 2 articles follow the same line, but I doubt it. It’s going to be tricky presenting a unique MSF position, when opinions diverge so much.

5. This article is not constructive. It exposes, once again, our problems at international level and the differing sensibilities that are hard to match up. I find this whole story lamentable. Once again, the field’s become a stake in intersectional squabbles. I hope it’s not like at nursery school, “you did it in December, I’m doing it in April, na na neh na” because that really would be the end.

Marie-Rose

INTERVIEW

Everything kicked off with the visit of Philippe Biberson and Pierre Salignon in March and early April. They came to Korea for ten days, we went pretty much everywhere with them, and when Philippe returned, he held a press conference, which made the front page of the ‘Libération.’ He spoke about the regime, MSF’s working conditions, and the living conditions for the population. He said that we didn’t have access to people. It was a carefully considered attack against a totalitarian country. He said that we hadn’t managed to evaluate the malnutrition problem because we didn’t have access to people; he described the hospital conditions, the conditions of the malnourished children. They did this like so. We weren’t aware of any of this in the field. We took it really badly, it caused a real storm. We weren’t happy that we hadn’t been forewarned. Which is not to say that we would have agreed. I really had the impression of being knifed in the back, because on leaving, Philippe had said that he wouldn’t do anything without warning us. Three days later, there was the front page of the ‘Libération!’ I was so upset.

We had quite a few problems with the authorities. Obviously when we put them on the front page of the ‘Libération’ by making outrageous remarks - which are true, I don’t deny it - but when we treat them as cannibals and accuse them of having diverted humanitarian aid, it doesn’t facilitate our working relationship! It didn’t help to create a climate of confidence. Yet it’s the sort of country where success depends on being friendly with people, creating a real climate of confidence.

Marie-Rose Pecchio, Coordinator, MSF Programme in DPRK, November 1997 to September 1998.

INTERVIEW

Marie-Rose was in the field, I wasn’t, it’s difficult to say whose word counts for more. I think that Philippe’s quotes in the ‘Libération’ must have made the authorities a bit angry, making the context and daily life even harder for the team over there. Marie-Rose was summoned by the authorities. But we weren’t aiming to have a good relationship with them. At best we wanted to avoid expulsion. The North Korean authorities were displeased and annoyed by witness accounts delivered abroad. But the country’s so far away, has such a bad image, that I’m not convinced that they were really so bothered. There’s no press in the country, foreign radios are forbidden, so they don’t give a damn.

Dr. Eric Goemaere, Executive Director MSF Belgium (in French).

INTERVIEW

It gives the impression that anybody can say anything, even if it’s someone highly placed in MSF. Philippe could have at least had a little prior discussion with the team. I understand that he didn’t discuss it with the other sections, that’s not Paris’ style, but he should have had enough respect for the field team to inform it beforehand. He didn’t. I raised this in the Brussels headquarters and I put my frustrations down in writing. Afterwards, I let it drop, because I was having enough problems keeping people in the field. I know that Eric spoke to Paris and he was much more in favour of a compromise. I wasn’t.

William Claus, MSF Belgium programme manager, (in French).

INTERVIEW

Then, there was an unexpected statement of Philippe Biberson, which, we were afraid, would create a rebound effect from the North Koreans. In fact, a couple of months earlier, Eric Goemaere from MSF Belgian also had made a press conference in Hong Kong, saying not very different things from which Philippe Biberson said later. But Philippe Biberson more clearly pointed to the responsibility of the North Korean authorities and their unwillingness to let us have access and to be open towards us - more clearly than Eric Goemare had done. So there was indeed a difference.

Pim De Graaf, MSF Holland Executive Director (in English).

INTERVIEW

What really worried me was that there were still some senior people in MSF who were saying that all this was a fuss about nothing; it was just publicity or yet another demonstration of how the French go about things, saying one thing and doing the opposite, treachery of some sort. It really proved to me that they hadn’t got it yet. We didn’t just take a decision like that, out of the blue, saying: ‘We’ll go back and go public.’ But as time went on it became obvious to us that we should: all the contacts taken up before we left, the incredible privilege we’d had of observing, understanding and being able to summarise the situation, all this practically obliged us to deliver our conclusions, at the risk of being a bit sensational. There was effectively a bit of sensationalism in these articles. But it was more the fault of Romain Franklin, the journalist, who relied on our good will. Nonetheless, our thoughts gradually became clearer on the issue. We considered that we couldn’t just stand by and say nothing, that we had to come back saying: ‘We’re almost certain that this country is doing really badly, that there’s big shortages.’ I think that’s’ exactly what we said: ‘There’s really big shortages that affect all levels of society.’ I returned for a board of directors’ meeting. Then I spoke to Brussels on the phone and we soon agreed that we had to go public with the question posed to the Korean authorities: ’Do we have the right or not to save people in Korea or is our aid going elsewhere?’ Brussels agreed with this. At the time Eric had already recognised to an extent that the message he’d passed during the Hong Kong press conference was beside the point.

Dr. Philippe Biberson, President MSF France, (in French).

On 8 April, 1998, back from its trip to the border www.video.12, the MSF Beijing team transmitted the report to the MSF France programme manager. The programme manager then forwarded the report to their MSF Belgium and MSF Holland colleagues. The issue was put on the agenda of the next programme managers meeting that would take place the day after. During this meeting on 9 April, the programme managers decided that MSF should stop its distribution programme in North Korea and renegotiate its modes of intervention with the authorities. MSF would carry on explaining its position regarding North Korea, and the accounts, compiled by MSF Beijing would no longer be given to journalists. However, in the meantime, the MSF France in China report had already been given to 5 selected press correspondents in Beijing. The team had also given some interviews and several newspapers had already published articles. Some of these articles focused particularly on stories of cannibalism that were reported by some refugees. The MSF North Korea team as well as the MSF Belgium and MSF Holland programme managers and executives, already annoyed by the quotes of MSF France president in Libération, were angered to have not been informed of the release of the report to the press. They expressed their disagreement with the MSF China coordinator statements. Several MSF executives also reacted strongly to what they perceived as an unprofessional move.

The Executive Director of MSF Belgium sent a letter to the FDRC General Director stating that this report did not represent MSF’s official position. In the meantime, the head of the World Food Programme threatened to reduce WFP aid delivery to North Korea if there was no improvement in the monitoring of the aid’s final destination.

DOCUMENT

Message from Pierre Salignon, MSF France Programme Manager, to Marcel Roux and Marine Buissonnière, MSF France in China, 7 April, 1998 (in French).

Extract:

Hi Marcel and Marine

Thanks a lot for your visit report. It’s really interesting… or should I say horrifying.

Several remarks:

1. Here are the main points I’ve retained from the document:

-The collected accounts mainly cover the ’97 period (April/August/December) and the end of last year (with the exception of the Chinese priest whose last visit goes back to January ’98).

So little recent info even if certain witnesses say nothing’s changed for the better, on the contrary (they receive letters, for example). Which seems logical. For info: the MSF programme started in September ’97 in the three southern provinces. The MSF B team only arrived in the northern province in early February and have barely started work. So there’s been no expatriate presence in the area up until now and no support with medicines (it’s different for food).

-Your accounts confirm information already made public by others sources (NGOs or journalists like Jasper Becker, whom you’ve spoken to me about and who for you information has just published a book in French called “Famine in North Korea. 1998: a Murdered People” (L’esprit Frappeur) with the same information on the lack of food, families breaking up, death, developing violence, the black market, inequality in the population when confronted with this tragedy, the ‘madness’ of the system, the privileges of the system.

-In your report I can distinguish direct witness accounts made by ‘refugees’ and Chinese/members of the Korean community in China who can travel to North Korea, and ‘indirect’ witness accounts of other people involved in the reception of individuals who have fled.

-The description of the population’s living conditions is terrible and completes the questions/interrogations raised by certain of our observations during our North Korean visit.

To summarise, I was struck by the following:

• A situation of food shortage/famine (without being able to extrapolate on the number of deaths despite the figures put forward by certain witnesses).

• The end of cereal distributions by North Korean authorities a year ago in the most favoured areas and several years ago elsewhere (it seems very variable depending on the witnesses, but it’s one of the important elements of information).

• Strong presumptions regarding the diversion of international aid/absence of distribution (food in particular) which doesn’t reach, or hardly reaches, the populations concerned.

• The absence of health structures in working order and the diversion of the few medicines still available to the black market (ref Eric Goemaere’s visit in December ’97 which confirms the witness accounts in your report regarding the empty hospitals).

• Economic industrial activity reduced to zero.

• The population’s constant search for food, wide-spread population movements despite the administrative restrictions.

• Nonetheless some exchanges with China without us knowing if they manage to improve the daily lot of the population.

• The Chinese authorities’ policy (in collusion with the North Korea authorities) for limiting the ‘refugee’ flow/passages over the border (difficult to establish a figure despite some accounts talking about 50,000/70,000 persons since 1996 or several dozens of passages - 30 to 90 (definitive?) per month. But whatever the case, we shouldn’t expect this type of witness account to produce precise figures. It’s not the most important issue).

• The area the witnesses talk about is relatively large and covers both border towns with China and other, further away locations.

• The witnesses who saw bodies in the streets, on the edges of the roads or on the Chinese banks of the river separating the 2 countries also correspond to the year 1997 (August to December ’97 + January ’98), which doesn’t detract anything from the gravity of the situation.

So that’s my summary of the main points I retained from your visit report (without forgetting all the other mines of information I don’t refer to. Please let me know if I’ve understood things correctly, and left nothing out.

2. Reading this report raises several questions, which you may be able to answer:

-We would like to know more about the people you met (I don’t need names) who gave these accounts. Particularly those who still have the possibility of getting in and out of the country and travelling around it. In a country as closed off as North Korea, these movements seem astonishing. They raise questions on the status of these people with regards to the regime in place in North Korea.

-A member of the network talked about the medical care provided for ‘the most serious cases’. Do you have more details on the state of new arrivals’ health? The witnesses talk about sores, wounds caused by the cold or skin diseases. What nutritional state are they in? Did you manage to collect a bit of data?

-We would also like to know why there are no witnesses who arrived after the beginning of ’98. Unless you didn’t send everything through due to lack of time.

-Do you know if the UNHCR in Beijing is interested in this refugee question? Thanks in advance.

3. Concerning the use of these witness accounts, the discourse to be held by MSF and the future of MSF in North Korea, I propose the following (I hope you received my visit report, which will already give you my and Philippe’s point of view on the operations in this country and MSF’s position).

-A meeting between the Desks is planned for Thursday the 9th in Brussels. I’ll send you the agenda, and we’ll be discussing MSF’s operational strategy and particularly communication + lobbying with regard to donors/NGOs.

-On Friday, still in Brussels, we’ll go over it all with the Operations Directors of the three sections (B/F/H), giving an overview of the Desks’ meeting. Which will allow us to see if everyone really is on the same track or note where there are disagreements.

-Conclusion: On Tuesday, we’ll do the minutes of the discussions and decisions taken on both operations and communications levels.

-I would also like to circulate your report to MSF B (William) and MSF H (Pim de Graef) tomorrow (Wednesday), so they can read it before the meeting on Thursday. It’s important to have all the elements on hand before discussing an information strategy and MSF’s position.

DOCUMENT

“DPRK Meeting Tomorrow or Friday!?” Email from Pierre Salignon, MSF France Programme Manager to William Claus, MSF Belgium Programme Manager, Pim de Graaf, MSF Holland Programme Manager copy to Mario Goethals, MSF Belgium Director of Operations and Brigitte Vasset, MSF France Director of Operations, 8 April 1998 (in English).

Extract:

I hope you are fine and we will organize a meeting this week on North Korea. We need time to discuss. That’s the reason why I feel we might meet soon. With Pim not coming tomorrow, I would like to know how you want to do now. William, thank you to keep me informed. On the other hand, I’m sending by fax to both of you this morning a report of the field visit of our team (in China) in the Liaoning and Jilin provinces bordering North Korea. This visit was decided when I was in China going to Pyongyang. The team spent 10 days in this area meeting with different local organizations, ‘refugees’ coming from North Korea or Chinese moving in an out North Korea. Sorry the report is in French. But I know anyway you can read it. You will see the information enclosed are interesting and confirming observations already done by other organizations/journalists. People speaking are mainly giving information on the period of April/December 97 (only one person visited NK in January 98). I also enclosed in this message copy of the mail a send to Marcel and Marine with some comments on their report. I’m waiting their reactions. I feel it would be important to speak about this report during our meeting. If you have comments, please send me a message. I will send it to Beijing. William, could you send this report to Pyongyang. I would like to have their comments too. That’s all for me. Sincerely, speak to you soon. Pierre

DOCUMENT

Letter from Dr Eric Goemare, MSF Belgium Executive Director to Mr Lee, FDRC General Director, 9 April, 1998 (in English).

Extract:

Dear Mr. Lee,

You heard certainly last week news forwarded by the international press that MSF had made declarations about an alarming food situation and misuse of food aid. We would like to stress that these news are not produced by any official MSF press release but have been extracted from interviews of Korean refugees made by MSF teams in China, part of their ongoing work with every kind of refugees in the country. Those interviews are not new, and are form the same source as different NGO’s in the past. We would like to stress that it was a totally personal initiative to release those information, initiative that is not backed by the headquarters, neither in Brussels, neither in Paris. About the content, it represents the refugees’ point of view but is in no way confirmed by the MSF teams present in the field neither by our mission last December in North Hamyong. We have launched that message to all the journalists that contacted us here in Europe.

We would ask you to consider keeping the meeting with Dr P. Biberson, President of MSF- France and our meeting in December as the official point of view of MSF on that subject. We will take this opportunity to reaffirm the importance for our team to have free access to the population, including at village level, to have a clearer view as an independent observer of the food situation and be able to put a definitive end to all kinds of rumours.

Sincerely yours

DOCUMENT

Minutes of DPRK meeting MSF B/F/H, Brussels, 9 April, 1998 (in English).

Extract:

Present - William Claus, Pierre Salignon, and Pim de Graaf. A debriefing with the directors of operations was done on Friday morning.

OPERATIONS

-MSF must stop its distribution programme or, at least, must reduce drastically the number of structures/provinces it is supporting. It is no longer possible to continue the way we do (cf. field visit report and constraints MSF teams are facing). Stopping/reducing ‘drastically’ drugs supply, doesn’t mean MSF would leave the country. However, certain conditions must exist, which do not exist today. MSF cannot continue working without being able to assess the real needs and having access to the population. Ethically, it is no longer acceptable and practically the distribution programme is too vast (number of structures... etc.).

-That’s why our priority is currently to assess as soon as possible the nutritional situation in North Korea.

-For that purpose, it was decided that William B would go back to NK end of April to negotiate again with the North Korean authorities the modalities of our intervention in the country. [...]

-In case there is no space for negotiation, MSF will have to take decisions regarding its involvement in this country. It is clear for Brussels, Paris and Amsterdam that our withdrawal could be an option. This should be explained to the FDRC.

-Negotiations are now open and a definitive decision must be taken in June 98 (our MoU ends in July 98 for the 3 provinces of the south and in September for the Northern Province in which MSF started to work in February 98). We will decide then what to do, how to continue, if we continue working in the country, until when, under which conditions. Sure, the last statements done by MSF Beijing could provoke reactions of the NK authorities. We will see in the coming days. But we must stay strong on our principles and the way we want to work in NK, and be clear with the authorities on the problems MSF is facing in-the country and the consequences in terms of the quality on our work. We must explain too why we spoke out in the media (be careful not to apologise because of that). [...]

-It’s clear for all of us that it is important to inform (in Europe/USA or on the field) all NGOs working in North Korea of our position and see if it is possible to develop a common approach in relation to the North Korean authorities. MSF must also address this issue with donors and foreign governments involved in the current North Korea crisis.

-It was decided to organise several meetings with donors and humanitarian actors working in North Korea in the coming weeks.

DOCUMENT

Reuters dispatch Beijing, 11 April, 1998 (in English).

Extract:

Starving North Koreans are resorting to violence and cannibalism to stay alive as army and government officials pilfer emergency relief supplies, said a report by Médecins Sans Frontières (MSF) seen in Beijing on Saturday. A bare minimum of food and medical supplies sent by international aid agencies to the famine-stricken nation had reached the sick and dying, the group said. Refugees and Chinese travellers interviewed by MSF on the Chinese side of the North Korean border described bodies lying in the streets, widespread violence and disease, and even cases of cannibalism.

Most supplies had been consumed or sold by the army despite efforts by aid groups to monitor distribution, they said. “Foreigners came to check that the grain had been distributed to the population,” said a teacher in the Chinese border town of Tumen. “After the foreigners had left, the government collected the sacks and never mentioned the aid again.” “The majority of aid goes to army and government cadres but never reaches the common people,” said a 34-year-old former North Korean state enterprise worker. Horror stories like that of a woman who ate her two-year-old child to save herself from starvation were commonplace, the interviewees said. “Our neighbour killed, salted and ate an orphan who nobody cared about,” the report quoted one 18-year-old orphan as saying.

[…] Most interviewees said the state had stopped issuing grain rations at least three years ago. “The government has not distributed grain since 1994 and I never heard anything about international aid,” said a Chinese driver who makes regular food delivery trips over the border. Witnesses said tuberculosis; typhoid and cholera were rife and medical supplies scarce. “Hospitals’ medicine has been sold on the market and hospital stocks are empty,” said one 34-year-old man. Others talked of large-scale population movement around North Korea. Many had died at railway stations as they waited to escape starvation. A member of a support group for North Korean refugees in China estimated that between 50,000 and 70,000 people had fled across the border since 1996.

DOCUMENT

“Food Aid Seems to Help Children in North Korea – but a UN Director Cites Distribution Flaws,” by Elisabeth Rosenthal, International Herald Tribune/The New York Times, Beijing, 11 April, 1998 (in English).

Extract:

BEJING - Young children in North Korea appear considerably better nourished than they did a year ago, presumably as a result of international food aid, the executive director of the UN World Food Programme said after a four day trip to that hunger-stricken nation. But the director, Catherine Bertini, criticized North Korean officials for failing to cooperate fully with her agency, which solicits and distributes most of the aid to the nation of 23 million people. In comments Sunday, she said that food donations would be scaled back if North Korea did not allow more widespread monitoring of how donated food was used.

Several reports, including one issued Saturday by the group Doctors Without Borders, have suggested that food aid earmarked for the general public is being eaten or stockpiled by officials and the army. […] Although Ms Bertini said that a serious food shortage continues in North Korea, she emphasized that children she saw in schools and day-care centres were generally far less sickly and emaciated than those she saw on a visit a year ago. She credited the almost 1 million tons of food aid that have poured into the country, most of which has been set aside for children under age 6. But she cautioned that there were still many cases of malnutrition among children. And she said that nutrition problems remain serious for the rest of the population - who must rely on their wits for what government food distribution has been unable to supply. [...]

Her sober assessment with its hints of progress contrasted with the far direr report Saturday by the doctors’ group, which was based on interviews with North Korean refugees who had crossed into China. The doctors’ report included grisly tales of village roads lined with corpses and hungry parents eating their children in desperation. These disparate accounts, within just 24 hours, further confused the debate about the seriousness of the food situation in North Korea, possibly the world’s most secretive nation. While no one doubts that there is widespread hunger and malnutrition, the question remains whether there is massive starvation as well.

Ms. Bettina said that the refugees’ statements, which have received front-page coverage in some Asian newspapers, were a source of concern to her agency. But she said the agency’s monitors “have not seen anything like what we’ve read in the newspapers”. Some food experts believe that the refugees exaggerate problems or report rumours instead of things they have personally witnessed or experienced. “Some say there are 3 million dead, other say there’s just a state of bad nutrition” said one aid expert who has worked in the region. “But we really don’t know; we have to be careful.”

DOCUMENT

“Food for Hungry Stolen by Army,” Jasper Becker, South China Morning Post, (Beijing), 11 April, 1998 (in English).

Extract:

International relief agencies sending food to the starving in North Korea are being tricked, as most aid is going to officials and the Army, witnesses say. A Médecins Sans Frontières report based on interviews with people on the Chinese side of the border says almost nothing is reaching those dying of disease and starvation. […] Most North Koreans interviewed said the state stopped issuing rations in 1995. Rations were halted five years ago in some places. A man from Hyesan whose five-year-old son starved to death said his family received one kilogram of rice last June. ‘I asked where it came from,’ he said. ‘They said, ‘Take it and don’t ask.’ I think it was international aid. This is the only time something like this happened. Most of the aid goes to army and government cadres but never to the people.’ A South Korean who had tried to set up a dental surgery in the North reported seeing chronic malnutrition and fresh graves. People were moving around the country in large numbers and some were being held in camps for vagrants. Many North Koreans spoke of cannibalism.

DOCUMENT

“Info,” Email from Pierre- Pascal Vandini, MSF France Programme Manager to Marcel Roux, Coordinator MSF France in Beijing, copied to Programme Managers, operations directors and executive directors of MSF France and MSF Belgium and the president of MSF France, 11 April, 1998 (in English).

Extract:

Hi Marcel

I’m writing this message to facilitate discussions. We have two problems:

- The risk of MSF’s expulsion from the DPRK.

- The loss of credibility with journalists right at a time when we want to talk about the situation in North Korea.

We owe this situation to you, and I’ll explain why. The info you passed to the press is of course known to MSF, particularly the DPRK team, Pierre and myself, Philippe, Brigitte, Karim, the board and the desks in Brussels and Amsterdam. So widely circulated within MSF. Nobody questions the witness accounts you’ve collected. The only question is how to use them. We all made a decision together - and that’s sufficiently rare that it deserves a mention - we all decided together on the strategy to adopt for North Korea during the international meetings of Thursday and Friday = firm negotiations with the Korean government in order to have direct access to the population. This is the only way we can respond to their needs (evaluation of nutritional status in the villages, active research for malnourished children, correct case management) and maybe eventually denounce the diversion of aid (document it, circulate info).

I think that you agree with these objectives: help and denounce. Unfortunately you’ve just pulled the rug out from under our feet and it seems unlikely that we’ll manage anything except leaving Korea. What you’ve done weakens MSF in negotiations and alienates us from Koreans. It weakens MSF, the Koreans are reinforced by your dramatic declarations, will have a great time pushing on the quantitative aspects (still more food, more seeds) whilst we want to focus on getting food to the beneficiaries, i.e. the qualitative ones. I don’t know if you’re aware of how difficult it is to negotiate with them in normal times. You alienate us from Koreans, meaning both the authorities and the people themselves. Your declarations on cannibalism are seriously insulting for the people. It’s an inhuman act and you accuse Koreans of having committed it. And then your declarations also specify that aid is partially diverted by the army. Our interlocutors, who are seriously paranoid, will lap up this kind of phrase.

We’re attempting damage control in Europe by circulating MSF’s real line, which is: numerous witness accounts collected over the years raise fears of serious food problems. MSF, which works in Korea, has not yet been able to confirm the extent of the catastrophe. None of the witness accounts have been confirmed by the MSF teams in Korea. We would therefore like to carry out a nutritional survey and increase our proximity with the most affected Koreans to be sure they are benefiting from our aid. Obviously, we can say all this to western journalists. But I have no idea how to deal with the fall out in the field … (the very day a North Korean delegation arrives in Beijing).

DOCUMENT

“’According to Witness Accounts Collected by MSF,’ North Korea: the Newly Damned of Asia,” Jean Leclerc of Sablon, Beijing, Le Figaro (France), 11-12 April, 1998 (in French).

Extract:

In North Korea, an entire population is dying of hunger, cold, exhaustion and violence. “Life was too hard, we were eating grass and roots. Children, orphaned or abandoned by their parents, were grappling with danger for survival. There’s no pity. Our neighbour killed, salted and ate an orphan that no one had taken in …” So say two escapees from the tragedy of Asia’s newly damned, a young 18 year old girl and her 8 year old brother, originally from Hambung in the south east coastal region, and taken in by an orphanage in Yanji, a town in North West China at the limits of North Korea and Siberia.

“At a guess, 15% to 20% of the population is dying of hunger, 5% is doing fine and the rest is trying to survive, but it’s exhausted. I saw the bodies of seven half naked children in January, all huddled up against each other. Nobody wanted to take them in. They took shelter in a pig sty before succumbing to the cold” relates a Chinese priest of Korean origins, who has family on the other side of the border. The UN is trying to put perspective on these two accounts amongst dozens of other odysseys of horror listened to and carefully recorded by a team from Médecins sans Frontières (MSF), who has just spent twelve days going up and down the Sino-North Korean border. They heard the accounts of some thirty North Korean refugees, smugglers and volunteers, Sino-Korean, South Korean or Chinese. These stories, coming from twelve different towns or provinces in the north of the peninsula, inhabited (in 1994) by 22 million people, tie in and tally with each other on the ‘details’, suggest that one of the biggest tragedies unfolding this century is taking place in the ‘earthly paradise’ created by the Stalinist regime of the dictator Kim II-Sung and his son and successor Kim Jong-II.

“Disinformation! It’s all manipulated by the American secret services”, cry diplomats from the European Union, who claim to have dispatched a dozen specialists in the field who didn’t see anything of this tragedy. The UN and numerous other humanitarian organisations have around a hundred representatives between them based in the capital, Pyongyang, who also said, when questioned on their return to Beijing:, “We shouldn’t dramatise things.” “The food situation isn’t desperate yet,” stated a World Food Programme representative recently. The problem is that most of these “humanitarian civil servants” can only travel outside the capital under strict surveillance and following officially decided itineraries.

During the ‘60s, a famine caused by the lies and cheating of Mao Zedong’s communist party leaders led to millions of deaths in China, yet the westerners invited to Beijing returned with ‘reassuring’ information: “The natural disasters have led to difficulties, for sure, but there’s no real famine!”

Are we once again going to hear, when it’s too late: “You didn’t realise?” [...] The people MSF met describe an exodus of poor wretches, barely clothed or shod, children with swollen bellies, faces blackened with cold, skin cracked. [...] Railway stations closed because the old and young collected there for their last gasp or in the last hope of salvation, bodies collected by army trucks at night, children sold for 5,000 Yuan (3,500 Francs) to Chinese peasants, cannibalism: the ‘French doctors’ picture misery in its most extreme forms. “My great aunt, who was 72 and educated in Russia, let herself die, saying that she’d lived long enough and preferred to leave the young their share of life” explained a trader from Tumen. Violence has become endemic, those who have nothing have to steal for survival: “It’s the only way to bring something in” said an unemployed 34 year old man from Hyesan, whose 5 year old son died of hunger. “We kill for food, we steal everything we can get our hands on, the only way to protect our possessions is to sleep on them – I’ve seen children steal bread from the mouths of adults,” confided another witnesses to MSF.

DOCUMENT

“Cannibalism Rumours N Korea,” Email from Janne Gustafsson, MSF Sweden Press Officer to MSF North Korea network, 12 April, 1998 (in English).

Extract:

Hello,

I just want to ask you if you know anything about these new rumours about cannibalism in North Korea, apparently credited to MSF F coordinator Marcel Roux in some vague way. I think it came via AFP a few days ago and it sounds a bit incredible that Roux would have said anything like that. I guess he must be misquoted. I was lucky enough to have a doctor here (Rikard Ljung) who just came out of North Korea and could balance the story a bit for the newspaper that called, but it would be good to KNOW what Roux really said.

DOCUMENT

“MSF Statement on North Korea,” Email from Catherine Harper, MSF UN Liaison Officer, New York to MSF North Korea network, 13 April, 1998 (in English).

Extract:

Hello everyone!

I was quite surprised to hear on Friday night, on CNN, MSF report on the situation in DPRK, with mention of cannibalism. From what I understood (as late as Thursday night), was that there was a meeting taking place in Brussels that day to define MSF’s position vis-à-vis DPRK, and therefore we expected to be informed sometime later (this week?) on it. Now MSF’s quote in various newspapers, including the NYT of today, is quite contradictory of earlier MSF statements, and is taking us by surprise. In fact, in various meetings here at the UN, MSF usually repeated that we could not confirm the dramatic figures used by some of our colleagues (including those of World Vision).

We are receiving a number of questions/inquiries raised both by journalists and colleagues, to which we are unable to answer correctly for lack of information. I thought that in previous circumstances, we agreed that we could not rely on - and therefore publish - accounts/interviews of refugees without verifying their stories, or at least to get some proof of it (which we know it’s impossible since we have no access there). I am sorry to say but I think that the way that this news has been published does not reflect well on MSF and we are loosing some credibility here. As the NYT article mentioned today, these disparate accounts (between Bertini’s sober assessment with its hints of progress and MSF’s report) further confused the debate about the seriousness of the food situation in North Korea; we acknowledged ourselves that the situation was very difficult to assess and therefore we need to be very careful. So why distribute this sudden information - which we could not verify -when we were not even informed ourselves??

DOCUMENT

“Food Crisis Overshadows Korea Talks,” Philippe Pons, The Guardian Weekly (Tokyo), 14 April, 1998 (in English).

Extract:

On April 11, just after a team of French doctors belonging to Médecins Sans Frontières (MSF) had reported evidence of alarming food shortages in North Korea near the border with China, talks between North and South Korea got under way again in Beijing. [...] According to the MSF report, published in Beijing on April 11, starving civilians have also been involved in acts of violence and looting. It is reported that corpses have been abandoned by the roadside, and that disease is rampant among the debilitated population. The North Korean authorities have admitted that the situation has worsened. Last week Pyongyang Radio took note of the “grave worries about the way food reserves are running out” that have been expressed by the head of the United Nations World Food Programme (WFP), Catherine Bertini, who has just visited North Korea. [...]

In January the WFP launched its biggest emergency aid operation for North Korea and called for 650,000 tonnes of foodstuffs to be contributed in 1998. The United States responded to the appeal by promising 200,000 tonnes. At the end of March, in the course of talks between Red Cross organisations in the two Koreas, South Korea pledged to supply 50,000 tonnes. The first consignments of that aid are due to arrive this week. But the great unknown factor, which could put off donors and delay deliveries, is the question of who the beneficiaries of that aid should be. Will it go to the population at large, or be given first to the regime’s elite and the army? Refugees questioned by MSF doctors have said that only a strict minimum of foodstuffs and medicines are reaching the civilian population.

DOCUMENT

“Sick and Tired of North Korea,” Letter from Marie-Rose Pecchio, Coordinator DPRK to the North Korea Programme Manager in MSF Belgium, 14 April, 1998 (in French).

Extract:

I read somewhere in ’97 that new rules over ‘témoignage’ had been decided by all the MSF sections and approved by the international office. These new controls have been disrespected twice in 11 days, both times in relation to the same mission, being North Korea. Remarks on the first occasion have already been circulated and copied around all the sections and persons involved, so I won’t go back over it. The second occasion, more serious in my opinion, involves some people describing what they’ve heard other people say. Not one fact has been checked or really seen by the person who passed these accounts to the press. Can we really talk about witnessing?? And not any old facts either, but really serious accusations: cannibalism, diversion of humanitarian aid to the army and higher echelons of the regime. And these accounts weren’t even passed on to the press with the normal reserves, used by others before him on the same subject.

And who’s witnessing? MSF! Or at least someone who calls himself MSF. What right does he have to talk in the name of MSF, about a mission that’s not his own, without consulting the people responsible in Paris, Amsterdam and Brussels? The 3 headquarters concerned, I believe: we’re an international mission. What right does someone have to omit informing a mission when he’s going to bring serious accusations against the country it’s trying to work in? I don’t even use the word ‘consult’, we’re way beyond that … I’m not going to give another overview of Korea: a closed off country, completely paranoid blah blah blah. This was sufficiently covered in Brussels during the meetings between desks and operations directors.

For my part, the FDRC is furious. It’s not excluding the possibility of asking us to leave the country. With the national holidays going on in Korea, I won’t be able to see them before Friday. Maybe we’ll be thrown out. Even if we’re not, it comes to the same thing, the damage is done, and in the name of MSF. Our good relationship with the authorities, the climate of confidence built up between MSF and its partners, the little bit of ground we’ve made (which is a lot compared to where we started from): it’s all finished. We’ll have to start again from scratch, spending huge amounts of time trying to re-build confidence, if we ever manage. And all this for facts that haven’t been checked and which others have been spreading about for a while, always without proof. We in Korea still haven’t received the dossier handed over to the press. Which is a bit of a joke, considering that the FDRC has it. So for once I’d like MSF to recognise that someone in our organisation, even if he’s super-protected by the nomenclature MSF F, has screwed up big time. And only MSF F can do this. He works for MSF F.

Marcel Roux, to name no names, which I spoke to yesterday on the telephone, considers that he will save more Korean lives with his report than we do in the field with our medicines. He can think what he likes. But I want you to know that enough’s enough. The Korean mission is sick and tired of all this. We’ve called on the International Office or Committee (I don’t know who does what) to take rapid measures against such acts that achieve nothing for anyone, other than trouble for people in the field who are just trying to do their job. Can we accept that such people, who don’t respect MSF’s internal rules, continue working for MSF? Humanitarian work is about helping people, but it starts with respecting them. And for us, accusing someone without proof lacks respect.

Marie-Rose and the North Korean team.

DOCUMENT

“For Your Info,” Email from Pierre Salignon, MSF France Programme Manager, to Patrick de Briey, MSF Belgium Programme Manager, 22 April,1998 (in French).

Extract:

Hi Patrick, I hope you’re well.

I would just like to react to the little messages sent by Marie Rose with the ‘savoury’ references to MSF France. I would be grateful if you could let her know that the decisions taken during the meeting in Brussels didn’t just come from Paris, but were accepted by all sections intervening in Korea. If I wrote up the minutes of the meeting, it was because William and Pim asked me to. I don’t want to send her a mail about this, as it’s not worth fanning the flames. I’m relying on your powers of persuasion when you have her on the phone. For sure, there was the Libération episode (the problem wasn’t that Philippe gave this interview, it was that the field wasn’t informed, which we regret. And we’ve said so).

There was the episode with Marcel Roux in China (regardless of what Pyongyang thinks about ‘manipulation’ from Paris, there wasn’t any, and you know it). Now there’s the ‘Marie-Rose annoyed with Paris’ episode, and I would really like her to adopt a more positive attitude and concentrate on negotiations with the authorities without finding Paris responsible for any current tensions with them. If there are tensions, it’s because this mission poses a real problem for MSF. When I see her little remarks on the visits of MSF directors who come to play politics, I’m concerned that she’s confusing the issue, and not concentrating on the most important one, being negotiations with the authorities (and there’s a lot of things to discuss). MSF’s position in the country poses a real problem in terms of ethics and the quality of our work. We shouldn’t hide this or refuse to raise it with the authorities through fear of being kicked out.

There you go, just a little word for you and William to let you know of my concerns about the coordination. I have confidence in Marie-Rose, but we shouldn’t let a fundamental problem be interpreted as an issue amongst sections. It’s not the case. I really hope that William gets his visa. It’s so important because we need to be clear with the authorities about all this.

DOCUMENT

“North Korea,” Letter from Anne-Marie Huby, MSF UK Executive Director to MSF North Korea network, (forwarded by William Claus, MSF Belgium Programme Manager to Patrick de Briey, MSF Belgium programme manager), 15 April, 1998 (in English).

Extract:

Dear all,

Like many others around the MSF network, I was gob-smacked to hear (from a BBC producer) that MSF had reported over the Easter weekend: “That famine drove North Koreans to cannibalism.” It is a great shame that one individual was allowed to derail our continuing efforts to highlight the real issues (i.e. 1/ we do not know exactly what is going on, so 2/ ‘free and fair’ nutritional surveys need to be conducted ASAP). Marcel’s media stunt is disastrous because:

A. MSF’s credibility is based on our presence in the field and our ability to provide first-hand accounts of a situation. We CANNOT AFFORD to conduct sub-journalistic enquiries and pass them off as fact-finding mission reports. The use of ‘interviews’ with refugees has been completely discredited in the UK - as a direct result of the Great Lakes crisis. The BBC, for instance, warns its producers and journalists against the use of such material. It was not easy to limit the damage done to our reputation over the last few days, while trying not to distance ourselves from a field colleague (and looking like a bunch of clowns in the process). If even journalists can have basic deontological rules, SURELY MSF OUGHT TO ENSURE THAT ITS FIELD STAFF IS EQUALLY PROFESSIONAL.

B. Every time we prepare to speak to the press, we have a clear idea of which coverage we actually want (if not, we should do another job!). Did MSF (Hong Kong, Beijing, whatever) aim to get “NORTH KOREANS EAT THEIR OWN KIDS” - type stories? Or did they want to raise the more subtle issue of the lack of monitoring? Whatever the answer, MSF was either IRRESPONSIBLE (and misleading, which is probably even worse), or PLAIN STUPID (you can’t expect journalists to print your finer points when dealing with such emotive issues as cannibalism). Take your pick. May I point out that it would have been perfectly possible to tell journos about these testimonies, as ANECDOTAL, supporting evidence, rather than as the gospel from a medical agency. It pains me to see what a bunch of amateurs we really are.

C. The story now looks like an inter-agency feud. Catherine Bertini, who had in effect rallied round our position last week, now has to discredit our testimonies (see today’s Herald Tribune). Instead of the real issue, we have ‘UN bashes MSF report’ - boring and wholly unnecessary. The only ones left off the hook are the North Koreans - well done. Which brings me to a final point...

WHO IS RESPONSIBLE?

MSF’s informality and ‘room for initiative’ is all wonderful and all that, but all too often there are no sanctions, or more importantly, no lessons learnt after a media (or other) fiasco. My question now is: what are you guys planning to do to ensure that our field staff play ball rather than go off and wage their own personal crusades? If someone from London or New York had landed you in this shit in the same way, we would expect our MSF career prospects to be somewhat curtailed – and quite rightly so. I look forward to your comments on this.

LAST BUT NOT LEAST: I need to see a copy of the report. Everyone has seen it, including the media – everyone except me. Could one charitable soul make my day a little easier and FAX IT please? Thanks. In case you were worried, I shall not circulate it further...

INTERVIEW

When we returned to Beijing, we felt that we had to write everything up, type out all the interviews with the refugees. We were astonished that nobody was talking about all this, because it was when questions were being asked about a possible famine in North Korea. We were in an incredible period during which this population was suffering an unimaginable degree of violence and yet it was taking place in total silence. On the contrary, North Koreas were talking about a return to normality, saying everything was fine. We said to ourselves that we had to get these stories out, one way or another. I don’t remember exactly how it happened, but we had contacts at the time with journalists based in Beijing who’d been following events in North Korea for a while. There weren’t many of them: Jasper Becker, who was still working for the South China Morning Post, was the first to write up stories of North Korean refugees in 1997; Jean Leclerc du Sablon, working for Le Figaro at the time, John Pomfret of The Washington Post, Francis Deron of Le Monde and Alain Extramiana of The AFP. We shared the contents of these witness accounts with them, as we were convinced that they should become public knowledge.

We didn’t go through the programme managers, but directly via Philippe Biberson [President MSF France]. I remember a phone call between Marcel [Roux, Coordinator MSF France in China] and Philippe Biberson. Marcel said he was going to make the witness accounts public and Philippe didn’t tell him not to. This interpretation of things caused a storm. I don’t have Philippe’s version, just Marcel’s. So we gave the accounts to journalists a few days after our return from the border, explaining what we’d seen and heard. Which led to the publication of articles at the beginning of April. Jean Leclerc du Sablon took a whole page in Le Figaro, using the following extracts: ‘The newly damned in Asia according to witness accounts collected by MSF.’ Jasper also did an article, we were in The Financial Times, the AFP published a story and Elisabeth Rosendale of The New York Times wrote a piece for The International Herald Tribune. I think that Eric Goemaere then distanced himself from us by writing a letter to the North Korean authorities. And I remember a row between Pierre Salignon (Programme Manager MSFF) and Marcel. Pierre was mad at shim because our dossier was ill prepared; it was missing sufficient solid elements to support the circulation of such information. I remember some really heated discussions.

Marine Buissonnière, administrator, MSF France in China, December 1996 to January 1999 (in French).

INTERVIEW

Things continued with Marcel Roux, the head of mission for MSF France in China. We often talked about North Korean refugees who crossed the border with China. Marcel went to the border, and on his return, there was an article in The South China Morning Post, a Chinese newspaper published in English, which talked about the diversion of humanitarian aid and cannibalism. This didn’t help relations with the authorities, which were getting worse and worse. They’d questioned some refugees and a Buddhist organisation looking after Koreans who’d slipped across the Chinese border. A whole dossier had been built up from these witness accounts. Amongst others, these refugees said there was cannibalism in North Korea. There were interviews with some 40 refugees. Can this be extrapolated across an entire country? They couldn’t be tallied up with anyone or anything. They only took the opinion of one side. And as for cannibalism, it completely contradicts Korean culture. Nobody knew about releasing this dossier to the press and it caused a real stink in Paris and Brussels. There were several articles on North Korea every year. Stories of refugees and cannibalism, which the Buddhists had already had published in the South China Morning Post a few months before, using the same sources. But MSF wasn’t the one denouncing, even if in Marcel Roux’s article, MSF was cited.

Marie-Rose Pecchio, Head of mission, MSF Programme in DPRK, November 1997 to September 1998.

INTERVIEW

Marcel Roux started circulating reports on statements that had been made before, claiming that there was cannibalism in North Korea, which didn’t help matters much. On one hand, you’re trying to negotiate to stay in the country and have more access and on the other, you have someone saying such things without proof. It’s serious, saying there’s cannibalism in the country. They’d interviewed people on the Chinese border who were being sheltered by religious Buddhist “sects”. The Buddhists had brought out a report; they brought out the same report shortly afterwards. It was the same people, some one hundred refugees.8 The people being questioned knew exactly what message they had to pass. It was Buddhists opposed to North Korea who’d been trying for years to pass the message that North Korea was going to be “Christianised” [sic!] and wanted to build up a really negative image. We never had any proof. There was a river border between South China and North Korea, and that winter the river was dry. If there’d been a famine, nothing would have stopped people from crossing, everyone would have done it. But this border was heavily controlled by the military. People always move when they’re hungry, whatever the context.

Paris always said that it was not aware of Marcel’s intentions. But I’ve worked with MSF for long enough to know that at least a few people knew about it. Marcel wasn’t mad enough to do something like that on his own; he must have had the back up of Pécoul [Bernard, General Director of MSF France] or someone else. It was once again an article aiming to shock without being capable of proving anything.

William Claus, MSF Belgium programme manager, (in French).

INTERVIEW

Marcel was in China, so he was interested in Korea. He and his team had a lot of freedom in their work. We were questioning MSF’s presence in North Korea. We were wondering what was going on in the country. Marcel was convinced that what we were seeing was not what was actually happening and he started digging for information on the border. I can’t put a date on it, but he said to us: ‘You’re kidding yourselves, it’s the worst regime in existence, the criteria used to select people receiving food are not what you think.’ And it was confirmed. I think that before his visit to the border, we had already formed an idea. But we know that when we’re busy inside a country, we also need an external point of view to help us keep perspective. And we agreed with Marcel from the outset that he should dig for information. Of course I had some rows with him on how he went about it. But there was never disagreement on the idea of communicating or the necessity of having this mirror effect, inside and outside. The problem was that he had such a full-frontal approach to his work... but having said that, this method has its uses at times. I remember a period of rich discussions, lead by Marcel, who was as feisty as ever.

Marcel didn’t act alone. We all agreed. Afterwards, he went a bit too far on the cannibalism, and that the press jumped on this point… that’s another issue. There was one of the witness accounts, which referred to cannibalism. I heard it again from other refugees I met. Certain elements of the media jumped on this point at the time. Marcel was depicting a horrifying situation. And he’s known for his capacity to draw people’s attention by saying things simply and cruelly. It’s possible that he draw particular attention to this account. It can’t be denied. But I don’t know for sure.

Pierre Salignon, MSF France programme manager, from October 1997 on, then MSF France Executive Director from January 2004 on

INTERVIEW

This story broke in Asia. They called us. We calmed things down a bit. I didn’t find Marcel’s declaration credible. I admit that I didn’t want to draw attention to this report. There was tension with MSF France because they said to us: ‘You’re censoring, you’re not playing the game. If there’s witnessing, you have to pass it on.’ I refused. I said to them: ‘It doesn’t cut the mustard. If I was a journalist at my programme manager and I received this information, I wouldn’t believe it.’ We often had friction with the different sections when the team here said: ‘It doesn’t stand up to tests. We know who we’re targeting.’ I think we’d demonstrated often enough that we had political courage that we could speak out, hold unpopular positions. I felt pretty at ease making personnel choices at times because I’d often delivered arguments that didn’t go down well. But I found this declaration on North Korea pointless. I was convinced that other people shared my doubts. Bearing witness is also about telling a story and when it comes across as hysterical and anti-communist, it’s just not credible. Hysteria’s OK when you’ve seen it yourself. But when you’re in China, eating your noodles every evening and thinking about things - it’s dangerous. I think that before bearing witness, we have to prepare things as if it’s a stage show, holding rehearsals and asking ourselves: are they going to believe us?

I often have the impression that in France, a traditionally Latin country, intention is more important than discipline. There’s a tendency to function as follows: ‘We have an idea and we look for proof to support it.’ This is acceptable when you have tangible proof or when you’re really concerned that a situation will deteriorate, as was the case for the Rwandan refugees in Zaire in 1996.9 But I think that we have to have proof, and in its absence we have to show that we have alarming factual elements. And then I think that certain people have very messianic positions with regards to North Korea. As if no one was aware that North Korea is a totalitarian regime, as if all humanitarian agencies are blind to the crimes being carried out on a daily basis.

I can’t help thinking that there’s a lot of neurosis on this issue. I know about the neurosis concerning revelations of evil linked to political issues. They are linked to the set up of socialism, the experiences of socialists. I can see which people have a problem of proof with regards to evil. In MSF, we attract enormous numbers of people who want to prove the existence of evil so we have a tendency to loose the plot a bit. So when people in MSF gave me a hard time about my refusal, I said: ‘Do as you like. But I don’t believe this story. Some people are so happy that evil communist totalitarianism continues to exist because it gives meaning to their lives. But it doesn’t necessarily make any sense in relation to our mission.’

Anne-Marie Huby, Executive Director, MSF UK (in French).

In Pyongyang, the North Korean authorities expressed their disagreement with the MSF statements directly to the coordinator. They also sent a letter on April 24 to MSF, which was copied to the EU and UN representatives in North Korea. At the same time, WFP, UNICEF and ECHO were negotiating authorisation to implement a nutritional survey.

DOCUMENT

Email from Marie-Rose Pecchio, Head of Mission MSF North Korea to William Claus, MSF Belgium programme manager, 19 April, 1998 (in French).

Extract:

Here’s the latest news in the MSF DPRK and FDRC saga. I met Mr Lee, the Acting Director of the FDRC, this afternoon (Saturday). In fact the real bone of contention is not so much Roux’s foolishness - that’s just the icing on the cake - but Biberson’s article, which questions the country’s politics. Here’s the essence of their message:

-The FDRC has given its support to directors’ visits with regard to the authorities (meaning the army) so visas could be issued.

-Every time someone from headquarters has visited, there are subsequent press releases that attack the regime. Eric, Philippe.

-The FDRC is in a very uncomfortable position and doesn’t know what decisions to take regarding MSF.

-The FDRC is well aware of the work accomplished for the Korean population by MSF, but observes with regret all the problems generated by the different directors. These types of problems don’t happen with the directors of other organisations, NGOs or the UN. So why with MSF?

-We’ve been able to do everything specified in our MoU. The nutritional survey was never included, so why ask for it?

-The FDRC doesn’t really understand why MSF sends out political messages when we’re humanitarian workers.

-They’ll keep me posted about the decisions taken. End. So that’s how things stand.

Re the nutritional survey, WFP + UNICEF + ECHO are in the process of getting permission for one because it is included in their MOU. Michel of ECHO thinks it can be carried out by the end of May, beginning of June. Let’s see. Whatever the case, it’s for the whole country and the NGOs present in the field will be associated with it. I suppose you’ve guessed that your visa’s not looking good. Sorry, but given the current glacial atmosphere, I’m not sure I’ll get it. You can scream and stamp your foot, it won’t change a thing. I’d have liked you to come so you could feel the atmosphere with the authorities for yourself. Too bad … I read the minutes of the desk meeting with great interest. So the French position wins, with their “everything, right now, or we leave.” I think it’s time to get our bags ready for July because the way we intend to go about things with the authorities will get us nowhere. I’ve never felt such a division between headquarters and the field as I did when I read these minutes, especially when Salignon’s seen how the authorities work here for himself, and spoken to people in the field. Has MSF B already merged with MSF F or is this just planned for the next general assembly?

DOCUMENT

Email from Marie-Rose Pecchio, coordinator, MSF DPRK to William Claus, MSF Belgium programme manager, 24 April, 1998 (in French).

Extract:

I’ve just come out of a meeting with FDRC, which was postponed 3 times. I was dealing with one of the acting directors, amongst others. The main points were:

-This type of thing is regrettable for the FDRC who has to account to its hierarchical superiors.

-The same authorities have pushed the FDRC to take serious measures on our account.

-Thanks to the explanations given, the FDRC managed to reduce the sanctions.

-The dialogue with the hierarchical superiors lasted a long time. I received a letter, which is attached to this fax.

-It’s not addressed to me because the errors in question come from outside the country.

-If such things happen again, it could be catastrophic for MSF and for him personally.

-MSF has to take measures to ensure that such things do not happen again.

-They are very positive with regards to MSF and hope that our work will continue. At this stage I explained that if we had more access, this sort of incident could be avoided.

-It should be born in mind that this is the first time they’ve worked with humanitarian organisations and they need time to digest our requests and come up with positive responses. And that hostile forces use the press to denigrate the country.

-That our good collaboration will continue in an attempt to satisfy our demands.

-That they’re aware of the problems raised and they’ll try to respond if possible.

-That it’s MSF’s directors who cause problems following their visits to the country.

-In the future, until indicated otherwise, the hierarchical authorities refuse to issue visas to senior headquarters staff. See my cc mail, sent this morning: it’s not just MSF, all agencies are concerned. I explained that the people in headquarters are our bosses and they come to evaluate our work.

-The FDRC cannot push for visas at the moment.

- The next time that something like this happens, they won’t be able to stop us getting thrown out. End of meeting.

I continue to defend MSF’s position to the FDRC, other agencies present here and MSF’s teams. I’m setting things out this way because this message is internal. Following this letter and my meeting, the MSF Hierarchy, as Patrick calls it, can react in 2 ways:

-Either we scream with rage and decide that it’s inadmissible, blah blah blah.

-Or we lie low because, in my opinion, we’ve got away with it lightly. This also conforms to my point of view that using strong-arm tactics, banging our fists on the table, wanting everything right away, will get us nowhere. We can easily obtain more access without figuring on a full page of the Libération. If we want to continue trying to do something in this country, we must choose the second option this time. But it’s up to you because it’s the hierarchy that decides. A final word, totally treacherous, I know, but I can’t help myself: I would like the decision to be taken by MSF B, who’s the leading section. If we ask the French’s opinion, such as I know them; they’re capable of holding a press conference for denouncing such an outrage …

Marie Rose

INTERVIEW

They didn’t want to see us for a whole week. Then we received a letter saying that we were letting ourselves be manipulated by the reactionary press (it was real Dante stuff) and the next time it happened, we were out.

Marie-Rose Pecchio, Coordinator DPRK, November 1997 to September 1998 (in French).

DOCUMENT

Letter from the Flood Damage Rehabilitation Committee, Democratic People’s Republic of Korea to Médecins Sans Frontières, Pyongyang 24 April 1998 (in English).

Extract:

It has been reported that Mr. Philippe Biberson - President of the MSF-France, who returned from a visit to our country last March, and the MSF team members in China served the ugly purpose of some media including UK and French papers for defiling and throwing mud at our country by providing them with some ill-founded materials which are not consistent at all with the present situation of our country and the distribution work of goods-in-aid. In December last year, Mr Eric Goemaere. General Director of the MSF Belgium, too, spoke of something contrary to our public health system this way and that, after his return from our country.

Such being the case, the FDRC cannot but express its serious apprehension about the MSF being misused by dishonest elements for their dirty political purpose of doing harm to us, instead of standing its aim to proceed aid work from the humanitarian principles. We are appreciative of the humanitarian aid offered by international organizations to our people, in temporary difficulties caused by natural disasters, but should not remain indifferent to any act of either slinging mud at us on the pretext of aid or distorting the reality. The FDRC calls MSF’s attention to the fact and makes it clear that in case such a matter would be repeated, then MSF would be held wholly responsible for all consequences arising thereafter.

INTERVIEW

And indeed, Marie-Rose was called by the authorities there to explain why MSF had made such an accusing statement. I went there also shortly afterwards - after Biberson but before MSF was called to explain itself, so I was just in between. I had also gone to the authorities and said well we are not satisfied with the situation and we will publicise that. But the words that Philippe had used, and the way that it was published was more than I would have done. I remember a discussion with our counterpart there - together with Marie-Rose - and I said, ‘we disagree with you and we will not keep our disagreement to ourselves.’ And they said on their side, ‘well, we don’t like that - ok - that’s your decision.’ That was a kind reaction from their side. But then - this is my understanding - the words that Philippe had chosen, triggered more criticism from their side, led to the decision that MSF would not be allowed to continue.

Pim De Graaf, MSF Holland Director of Operations (in English).

INTERVIEW

I don’t think this period of tension had any direct consequences, either in operational terms for MSF in North Korea - even if in the North Korean authorities eyes’ we’d always been killjoys about running around in circles – or in China. Negotiations with North Korea had come unstuck over our operational demands, not over the choice of words being employed at the time. This didn’t have any repercussions on either the Chinese programme or our capacity to return to the border and carry out more in-depth work with the refugees. On the other hand, it did create a drama within MSF. Marie-Rose Pecchio, who was coordinating the MSF team in North Korea at the time, telephoned Marcel. She was furious, telling him that he was mad and we were putting MSF’s possibility of working in North Korea at risk. For Marie-Rose, our statements and presentation of the situation as described to us by the North Koreans risked endangering MSF’s presence in North Korea, particularly at a time when Marie-Rose and Dominique felt they could gain some working space in the nutritional centres and make some progress with accessing the children in centres 9-27.

Marine Buissonnière, administrator, MSF France in China, December 1996 to January 1999 (in French).

INTERVIEW

The influence of those contacts with the press were very negative for us on the field. In June/July we had to negotiate a new MoU, to see how to go on, and in my memory, the management team was only busy with the FDRC, repairing what had been broken by the head offices. I think the trust has been damaged. I think that the press statements harmed the cooperation. And it was not for me in the field because we didn’t know we were having these statements, but I saw how much energy from the management team went into restoring this relationship and also to get Belgium and France on one line. It has influenced the future of the project. I thought it was because of the press releases but maybe it would have gone wrong anyway.

Dr. Corien Swann, physician, MSF Programme in DPRK, January to September 1998 (in English).

In New York, the MSF USA team intensified its efforts to explain the MSF position to the United Nations, the US Congress, the US State department and the American NGOs.

DOCUMENT

“North Korea Working Group Meeting, Washington D.C, April 23, 1998,” Message from Antoine Gérard, MSF USA Programme Officer to MSF North Korea network, 5 May 1998 (in English).

Extract:

I- InterAction Meeting:

MSF USA has been requested to provide information regarding the testimonies collected among the refugees at the Chinese-North Korean border. I clarified our position and the concern we have about the situation in the country. Then I provided some information on MSF activity in North Korea and the conclusions of the latest visit of the desk and the President. As comments, some US organizations expressed their wishes to operate in NK and are not favourable on speaking out about the difficulties the NGOs are facing in term of monitoring their activities.

The US organizations have been questioning MSF in term of financial independence in NK. Some of the rep. expressed strongly that MSF may have a need now to re-assess its activities knowing that European Union wishes to reduce it support to the International NGOs involved in NK. (I wasn’t aware of the EU NGO financing policy in NK, I stated that MSF has enough financial independence to run programs with or without the support of any donors...).

InterAction and Mercy Corps expressed their concern on the lack of coordination among International NGOs, specifically when concerns expressed on the operational difficulties. “MSF is free to re assess its program but should coordinate with the others, should associate its efforts to the others.”

[…] III- Reception at the Congress Hunger Center

Congressman Tony Hall organized a welcome drink for the FDRC delegation. It was a chance to raise some concerns to a congressman on the negative effects of large uncontrolled unmonitored food aid to NK. Some further contact will be developed with this congressman.

IV- Questions and Suggestions: Briefly, I would like to share with you some points.

1. What is MSF position towards the nutritional assessment, which should take place in the coming weeks by WFP/UNICEF and EU?

2. How far MSF is independent financially from ECHO? Is there any plan of action to diverse our funds?

3. Should we rely on gov. funds for such a country, due to the heavily interests of the major donors?

4. Did we develop a strong advocacy to the different UN agencies involved in NK as UNICEF and WFP? If yes, can I get any feedback of such meetings in Europe or in NK?

5. NK is an extremely sensitive issue among my US NGO colleagues, can I get some quick feedback from our field team members on their perception of the US NGOs’ work in NK.

6. Any advocacy campaign developed in the States at different levels of the Administration and the Congress should be coupled to similar work in Europe. Refugees International is pleased to address a letter of concern to Tony Hall, who can easily address it to Madeleine Albright. But it will be more significant if we can have some similar actions taken in Europe (Letter to Ema Bonino, to WFP etc.).

7. I don’t share at all the view of my US colleagues that the North Korean authorities have no western culture therefore they can’t fulfil and understand the requirements of the International NGOs as MSF. Believe me or not, Ambassador Kim Su Man of FDRC has a better understanding of American policy and culture that many of us at MSF. We should not cultivate the naive idea, which is shared among US NGO rep. and more UN agency rep. that we should give time to the North Korean authorities to understand the Western requirements of action for implementing relief program for the NK population. It is amazing that FDRC, which is the negotiating body for the NGOs, is pretending not to have control of the North Korean decision making process... It reminds of me when I was in Khartoum (Sudan) and we had to swing between the different Sudanese relief governmental departments and Ministry of Health officers... This is an old strategy and MSF has a long experience of such Governmental-No-Decision-Taking-Bodies... End

INTERVIEW

Pierre and above all Philippe wanted me to get on top of the North Korea dossier as soon as possible. They asked me to take part in the Paris board of directors’ meeting in March so I could start working on the issue in the United States. I remember that Pierre gave his presentation and Maurice [Nègre, member of MSF France’s board of directors] said to him: ‘a communist regime is always a communist regime; you’re not saying anything new. We didn’t need to go there to discover all this.’ I started raising North Korea during American NGO meetings in April. They were attended by a certain Deborah Deyang, Tony Halls’ assistant. I said to them: ‘we’re carrying out an evaluation in MSF at the moment. We have the impression that access to the population doesn’t exist. We’re in a phase of renegotiation with the Korean government. We’ve set down a number of demands. If they’re not taken into account, we’ll start pulling out.’ Tony Hall and his assistant were livid at the idea of us upsetting the apple cart.

Antoine Gérard, Head of Programmes Department, MSF USA (in French).

On 24 April 1998, the MSF France coordinator in China reported on his mission to the China - North Korea border to the MSF France board. After an extensive debate about the relevance of MSF operations in North Korea, the board concluded that MSF should stay and speak out.

On 29 April 1998, the MSF Programme Managers met and decided that MSF would do its best to stay in North Korea, support the field team, follow up the issue raised by the refugees’ testimonies, and actively lobby the other humanitarian players in order to increase the pressure on the authorities.

DOCUMENT

Minutes of MSF France’s Board Meeting, 24 April 1998 (in French).

Extract:

Exploratory mission to the Chinese/North Korean border (Marcel Roux)

Following their visit to North Korea a month ago, Philippe B and Pierre shared their doubts about the quality of MSF’s work in this mission: only delivering medicines and material, no access to the population, impossible to communicate with and treat people… A month ago, Marcel managed to collect some testimonies from people involved with North Korean refugees in the northeastern provinces of China:

- Religious networks active in the region for the last 2 years.

- Members of Korean minorities living in China (with family in Korea).

- Chinese living on the border.

- North Korean refugees, etc.

All the witness accounts coincided in their nightmarish description of the situation. There’s probably a monumental famine going on, which has been kept completely secret. Humanitarian aid doesn’t reach the population and probably only serves to bolster those in power: no food distribution for at least three years; people dying everywhere (all the people questioned had lost family members: from disease, hunger, etc.), no access to medicines which are completely unaffordable, no access to healthcare: the hospitals are empty. Family units have collapsed, people are taking to the roads; apparently there are frequent cases of cannibalism… The situation is appalling, a catastrophe. A collection of testimonies drawn up by Jasper Becker (a journalist) has been forwarded to Paris. The information they contain confirms that North Korea has fallen victim to a major crisis: it’s a mad country, closed off. The population is trapped with no possibilities of escape. Like a sect pushing its beliefs to the limit whilst holding a helpless population in its clutches. The Koreans believe that the rest of the world is in the same boat. So they don’t have the reflex to revolt, complain or even speak out. They’ve given up all hope, and know nothing of all the international aid. People don’t farm, there are no seeds left, no fuel or electricity...The social violence is extreme. People kill to steal. The population’s going mad. Children are killed (they represent food…). Marcel thinks that the exploratory mission only confirmed what others have already said. There have probably been between 1 and 3 million deaths…

Is this picture over-dramatised?

Philippe B. pointed out that after spending 10 days in North Korea, and despite his feeling that everything was set up with a masterly touch, he still couldn’t go along with everything Marcel said. It’s true that there’s no more production, no more commerce, but some regions are definitely more affected than others, and some layers of the population are struggling more than others. Marcel replied that probably only 15 to 20% of the population live decently. The system is so perverse that these people are used to mount the ‘set ups’ to save the nation’s face and demonstrate access to health care, medication, and food. But around 50% of the population are living through a complete nightmare.

What’s the situation on the border between North Korea and China? It’s a Siberian region and cold for at least 8 months of the year. People attempting to cross the border are often picked up by the North Koreans. Any Chinese caught taking them in are punished with fines. A bonus is offered to those denouncing clandestine arrivals. Women and children can be bought… The Chinese side of the border is thickly wooded, making it impossible to estimate the number of people hiding there. Odysséas asked if we could establish some quantitative benchmarks and measure the developments. Most of the witness accounts coincide in terms of time and geography. It’s difficult to come up with percentages. But it is nonetheless possible to say that for 23 million inhabitants, a mortality of 20 per 10,000 per year amounts to around 500,000 deaths. A mortality of 2/10,000/day (alert threshold for refugee camps) amounts to 1.5 million deaths a year. This comes to 4 to 5 million deaths in three years. It’s absolutely possible, when we think about it. (Philippe B).

Such an evaluation can only be empirical, said Marcel. The bottom line has long been: no food distribution and many deaths from starvation. The aid being delivered is probably insufficient, falling short of around 2.5 to 3 million tonnes of food a year. In any event, however much food arrives in the country, it goes to those in power and not to the general population. The World Food Programme is not sharing all the information it has. Hundreds of millions of dollars are invested in humanitarian aid in North Korea. If news of the famine gets out, the loss of credibility would be enormous. Jean-Hervé pointed out that we shouldn’t succumb to needing methods for proof, which is the WFP’s problem, for example, when it has to carry out a nutritional survey to prove that if people eat less, they become malnourished! Totalitarian regimes can be impenetrable during external visits and hide huge catastrophes. The North Koreans are undoubtedly in serious difficulties.

The collapse of a political system

For Philippe B, it’s more than just a famine; it’s a shortage across the board with a total collapse of the economy and the population suffering the consequences. The country depends on a distribution system, so we can easily imagine how serious the situation becomes if this distribution stops… The regime is worn-out, absurd, and starving its people. Why does the international community give it such support? For Jean-Hervé, the real issue is why the European community and the United States support this dictatorship. The subject seems ultra-sensitive politically. The issues at stake:

-Collective security, with regard to the nuclear question.

-Economic security, with regard to the economic collapse in Asia and particularly South Korea.

China, South Korea and Japan are the main providers of humanitarian aid to North Korea. They circulate no information on the situation in the country and we can imagine that they don’t want their Korean brothers to loose face. Everything is done to avoid the regime collapsing and a move towards the catastrophic scenario of reunification. China is obviously keen to avoid millions of refugees pouring over its borders. What position should MSF take in all this? For Jean-Hervé the decision is vital. We should not get it wrong tonight during the board of directors’ meeting. Everyone agrees that it is impossible to continue like this, with no control over what we do. MSF should remain in the country and speak out. This is the most powerful strategy (Jean-Hervé, Marc, etc.). We should say that we don’t have access to information and we can’t do our work (Christiane). After some resistance, doubts and the normal questioning, MSF France, Holland, and Belgium all agreed on the evaluation of the situation (Pierre). Why not ask for an enquiry commission at the UN? (Odile)? Would it be useful to speak to a group of deputies or senators and encourage journalistic enquiries in the field (Jean-Luc)? Philippe B and Jean-Hervé think it should be possible to ask for a team of journalists to accompany us for a visit.

Conclusion:

MSF will stay in North Korea and speak out. We have every reason to fight against the Korean authorities and those who support them. Our presence would be harmful if we kept silent, pretending that our aid was effective. We will say – in full knowledge of the cause – that we’ve reached an impasse.

DOCUMENT

”Summary Conclusions North Korea Meeting,” Email from Patrick de Briey, MSF Belgium Programme Manager, to Programme Managers and operations directors of MSF Belgium, MSF France and MSF Holland, 30 April 1998 (in French).

Extract:

Conclusions:

- MSF is in North Korea and doesn’t want to get expelled; this should be born in mind at all times.

- Give active support to teams in the field: to be provided through increased transparency, circulation of all info.

- Carry out deeper investigations of the issues raised by the witness accounts collected in China.

- Send a new mission to SOUTHERN CHINA and/or VLADIVOSTOK for the collection of more recent accounts to increase the credibility of the existing accounts and for crosschecking with access/or not to international aid.

- At the same time, in North Korea, try and regroup the data in an attempt to draw up a ‘humanitarian aid’ map which gives us clear answers on WHERE, SINCE WHEN and HOW MUCH aid has been distributed.

- Active lobbying with other humanitarian actors: ECHO/WFP/UNICEF/ICRC/MDM/ACF /OXFAM; contacts, sharing our reflections, enhancing mutual experiences, etc. with the aim of increasing pressure on the authorities in terms of access. Avoid taking all these steps/witnessing alone.

- At communications level: put reigns on Marcel regarding all declarations/communications linked to his ‘report’; if there’s any sort of info or important event, obligatory agreement required from headquarters and field for all decisions on communications.

- Marcel and Marie-Rose to meet in Beijing before MSF F’s coordinators’ week to go over things.

DOCUMENT

Email from Pierre Salignon, MSF France Programme Manager to Marie-Christine Ferrir, Director of Operations MSF Belgium, 30 April 1998 (in French).

Extract:

On the USA side, Antoine Gérard […] will write up an overview during the next few days of all the meetings he’s had with the UN (UNDP, UNICEF, WFP), US NGOs, people from Congress and the State department. He’s done a great job of lobbying and explaining MSF’s position/the questions we’re asking ourselves.

On the FDRC side, do you agree that we should reply to the letter received last week? Not for throwing another punch but for re-stating the urgency of discussing our future collaboration after July ‘98 on the following principles: reducing the distribution of medicines, access to the population, freedom to evaluate, targeting our actions. We could take the opportunity to insist on the importance of William’s visa (or someone else’s if he’s not available). This letter would not prevent Marie-Rose from having discussions with the authorities as of now on the problems encountered by the teams and MSF doctors having access to people’s homes and accompanying local doctors during their home visits. On the Chinese border front, you went over this yesterday and Marcel explained the caution required for follow up. If I’ve understood properly, we agree to go further in depth in our reflections on the subject, returning to the border to collect recent testimonies and matching the information up with data from the field teams in North Korea (I’ll look at the dossier Marcel brought back with him. There’s a detailed map of where the refugees come from that I’ll send to you ASAP).

Could you let me know if you agree with all this? […] Last point: I’m working with François Jean to establish contacts with academics and others familiar with North Korea in order to obtain more information on the current context etc. There are some contacts and avenues to be explored in Paris next week. I’ll keep you informed.

DOCUMENT

“The Voice of the Field,” Email from MSF Pyongyang to MSF Belgium programme manager, 4 May 1998 (in English).

Extract:

We had a team meeting, this Sunday, where among others points, we discussed about the resolutions taken, after the meeting M. Roux, E. Goemaere, P. Biberson, M.C. Ferrir, Patrick de Briey.

1. We agree completely with the decisions taken about:

- The international mission. We have no problems at all with that. It seems there are only problems between head quarters. We hope these are solved because they interfere too much on the operations in the field.

- Active lobbying with ECHO-WFP-UNICEF- [...] We ask to have information about what will be told, to be able to say the same locally. This first point has been agreed without discussion. For the others, they have been discussed.

2. Marcel Roux: we understood that it has been a decision of MSF F to keep him as a MSF F member. If MSF F doesn’t see the point (no respect of the international MSF rules, destruction of months of building good relations with the authorities, ...) it is up to MSF F. We hope MSF F will not regret its decision.

3. We can agree with a new assessment on the border, it is interesting, no doubt. We are doing drugs distribution on the field and no food distribution. […] First of all, we are responsible for témoignage in the areas/field where we work, in four provinces, not at the border. Second, we are not responsible for investigation the ‘re-routing’ of goods not supplied by us. We need to have clear objectives why, we, as MSF should do this assessment.

4. WE WILL NEVER AGREE THAT MARCEL ROUX WILL DO THIS NEW ASSESSMENT.

- We believe that he cannot be objective anymore after the big mess after his previous mission because he will want to prove he was right.

- The journalists know him and they will know when he will go. We don’t think he will be able to shut up at his return.

- We don’t trust, at all his promise. He acts out-of-control and solitary.

- We don’t understand how he is allowed to go back in China and be the referral person for the journalists about North Korea. He will be the ‘Sword of Damocles’ for the North Korea mission.

- We are sure that the headquarters can find somebody else who will have the right competences to do it in a right and proper way. For us, it is important to have clear terms of reference for this mission.

5. We act on the will, from the H.Q., and on the transparency and transmission of information to the field. We want to trust that...

In conclusion, we can tell that since 2 months, this mission is a big ‘bordel’. Visits of president, desks, press releases, interviews, fightings and insults. [...] We hope it is finished now. We want to try to do some work, in the way of MSF rules. We will only try. We are not sure to succeed. We want to remind everybody who wants to have some moments of personal glory that we got our last chance. This has been made very clear to us. We hope that the decisions taken at this meeting will be followed by everybody.

INTERVIEW

We started spreading the net. We wanted to prepare a visit by François [Jean], which would allow us to explore and improve our understanding of what was going on in North Korea. Obviously we needed to look into the discrepancies between statements collected outside the country and what our team was saying from within it, but we also needed to study the information gathered from refugee accounts regarding the organisation of assistance in the country. Meaning how assistance is distributed according to class and the channelling of international assistance through the public distribution system, which discriminates against the population according to its social utility and political loyalty. We would build a clearer understanding of these things at a later stage, but we’d already started to get a feeling for how the assistance system operated in this totalitarian regime and we knew that we had to be more proactive and document it.

Marine Buissonnière, administrator, MSF France in China, December 1996 to January 1999 (in French).

At that time, some members of the MSF team received more evidence that not all of the drugs provided by MSF were being used to treat the patients. They figured out that the North Korean doctors were saving these drugs in case of a possible MSF withdrawal.

INTERVIEW

When we arrived, the drugs were always all gone, all used. It’s not only typical for North Korea but for a lot of countries! But on the other hand we didn’t see that many patients. So we started checking things in the pharmacy, first to see how the drugs were stored, if they were stored in a dry place, and then, in the second phase we checked how they were used, how they were prescribed. Then the next phase came; ok the drugs are gone but can you say when they are given?? In my third or fourth month, my translator also got a bit enthusiastic and she started also checking things and she said: ‘Corien, it’s not true, it can’t be.’ I was already thinking that, but after three months I also got [motivated] her on the job! Which was a bit funny because there isn’t much trust, everything is filtered, her reaction should be filtered as well. She was pro-ideology, and she was perfect example of a daughter of Kim-Il-Sung. When I heard her translate, ‘where are the drugs?’ I could also hear in her voice, ‘how can it be like that?’

In the fourth or fifth month, they started saying in the pharmacy that they had saved a bit, so I said, ‘ok, it’s not a big problem, we just have to be informed for ordering new drugs.’ To keep a good relationship, we weren’t cross-checking everything because we would have problems then, it would spoil your relationships. It was not easy for them to explain because it wasn’t something they were proud of. They said that they hadn’t had drugs for a long time and that they just wanted to save them because they didn’t know how long MSF would stay, how the supplies would go on. I could only imagine. I could understand them. Herbert, my predecessor, wrote that when he arrived there wasn’t anything in the hospital. They were built 30 or 40 years before and everything was re-used and re-used. There were no bandages; everything was old and broken but re-fixed. And suddenly, they received 50 boxes of medicines. It’s just a normal attitude after 30 or 40 of having nothing, and re-using, and re-using. You don’t start using everything; you store it and start little by little using it. That’s what my predecessor had told me, ‘they’re using only tiny bits at the time.’ You have to say, ‘please use it, it’s for the people here. If they have pneumonia use the entire antibiotic course and don’t stop after two days because they are feeling better, we will re supply.’ So we really had to push them to use but it was very understandable. When given so many boxes, of course they’d want to keep them!

But the other part was that I was not able to be a real private investigator to count all the boxes and compare with what was missing. And I couldn’t be sure that boxes that were there today were not transported that evening to the next county. And at the end, they were right, we stopped in August, there was no re-supply after August. But easily the ministries in Pyongyang could have said, ‘ok, these boxes, tomorrow they go to the military.’ Yes, there was a conflict of interest.

Dr. Corien Swan, Physician, MSF North DPRK, January to August 1998 (in English).

INTERVIEW

Week after week, relations were increasingly straightforward and direct. There were a few issues with hidden medicines from time to time. Medicines were diverted. But I’ve always maintained that even if the medicines weren’t used where we wanted them to be used, they were in a room next door. If we insisted, saying that we wouldn’t leave without looking over the medicines, we always ended up seeing them. We never saw medicines being given to the army. Things were very clear in that respect. The message denouncing the diversion of humanitarian aid was sometimes issued outside the country – it became the diversion of humanitarian aid – but we never really talked about the diversion of medicines, because this was never proven. Once we’d gone, who knows if these medicines were put to bad use? But whilst we were there, we were strict on the issue, which meant that we almost always knew where they were.

Dominique Lafontaine, physician, MSF programme in DPRK, August 1997 to September 1998 (in French).

In May 1998, the WFP team started to organize a nutritional survey in North Korea together with UNICEF and ECHO. No NGO was involved in this project and the target population of the survey was chosen so that it could justify the WFP programme. On 19 May the WFP programme director announced that the agency would cut its aid to North Korea because it had no access to the entire country.

DOCUMENT

“Nutritional Survey in the DPRK,” Email from Sonia de Meyere, MSF DPRK, to MSF Belgium, France and Holland Programme Managers, 11 May 1998 (in English).

Extract:

The WFP nutritionist called for a meeting with all the NGO’s present in the country to discuss this draft protocol, as they have no experience with nutritional surveys and have little information about what is happening in the field.

Collaboration with the NGO’s:

It was an agreement with the government to conduct this survey with 3 organisations: UNICEF, WFP and ECHO, no other agencies will be allowed to assist in the data collection in the field, they will maybe discuss if the other UN agencies (WHO and FAO) can participate, but the government wants as few foreigners as possible involved in this, the expatriates will even not be allowed to weigh or measure, this will be done by people from the ICN (Institute for Child Nutrition ), the expatriate is allowed to record the data. Input from the NGO’s: to discuss about the protocol, to obtain practical information about health structures in the counties.

Timetable:

June is the month!!! Collection of data is expected to be done the second half of June, the analysis beginning of July, however negotiations with the government might take some time especially where the household visits come into the picture.

Target population:

A lot of discussions about the group of children to be included in this survey, following this protocol the under fives would be almost excluded, so where is the nutritional survey? This question clarified the objective of WFP: they would like to have a justification for their food distribution for the children in the primary schools, pregnant, and lactating women, these are new target groups for them, this needs to be justified. It was finally agreed that the under five should also be included in the survey, a sampling expert will be asked for.

At random survey:

They all agree that a screening of 4,000 children as has been done before will not be repeated. Problems to resolve:

- Choose counties at random when about 20% of them are not accessible because of security.

- How to select pregnant women? (The food monitoring form could include the data needed). - How to avoid the bias of the children not present at school but in the hospitals or at home?

Conclusion: the draft will be rewritten; we will get an update this Friday (the nutritionist leaves the country on Saturday).

Remarks:

- It is rather clear that we will not participate in this survey.

- It will be very interesting to see how the discussions will go on with the authorities to obtain access at random.

- The importance for us to be present at their information-gathering meeting is:

* To try at least to have a reasonable draft protocol.

* To be aware of their methodology to be able later to interpret the results.

DOCUMENT

“The Nutritional Survey,” Email from William Claus, MSF Belgium Programme Manager to MSF France and MSF Holland Programme Managers and to MSF Pyongyang, 19 May 1998 (in English).

Extract:

I hope everybody saw the message from Sonja concerning the planned nutritional survey. This scenario was more or less foreseen and is going to block our strategy as it was discussed during the last inter-desk meeting. I think we must intensify our lobbying strategy and try to convince or influence the political decision makers to avoid that another nut survey, which will be nonsense. It is not up to UN agencies to make nut surveys when they are not involved in the implementation on the field itself. Another alarming phenomenon is that there is no reaction or position of the other actors involved in NK. A phone call to the Red Cross Federation in Geneva taught me that nobody was aware of the latest events and this is the second most important actor on the field.

What we have to propose or to explain.

1. WFP is responsible for the food distribution. Since the beginning of this operation, the whole operation was questioned; is/was there a famine or not and if the accessibility to the distribution was correct or not. Until now nobody has the slightest idea if food reached the population or not. This should be the first (and most important) angle for WFP to do an evaluation. It is not through a nut. survey but by using tools like food basket monitoring that they will have a better opinion or view on it.

2. To use a tool such as a nut survey to justify the next action without knowing what was happening in the past is illogical and must be avoided.

3. The methodology is unclear as it was before but what is unacceptable is that all the measuring on the field will be done by the Koreans. So again, no access to households, again a bias on the choice of the sample.

4. Only UN agencies are allowed by the government to implement a survey. NGOs are completely out of the game, which is unacceptable as they are the main actors on the field.

5. The position of MSF will be very difficult if we are not able to evaluate one year of TFC programmes.

So these are enough reasons to re-explain our position and the importance of having access to the population to get a clear picture of the health status of the population. Therefore, I propose that we contact the organisations, which are active on the field (we can use the list as we agreed upon during the last meeting).

DOCUMENT

“UN Agency to Cut North Korea Food Aid,” The New York Times (USA), 19 May 1998 (in English).

Extract:

The United Nations World Food Program will cut back aid to North Korea because it reneged on its promise to provide access to the entire country, the program’s director said today. North Korea assured United Nations relief officials last month that it would let workers with the Rome-based World Food Program into all 210 counties, including areas that it had designated as off-limits for security reasons, said Catherine Bertini, the program’s director. However, the agency has been granted only partial access and has been refused entry to 39 counties that it specifically sought to enter, Ms. Bertini said. The agency had expressed concern about lack of access because it could not monitor whether the food was reaching the people for whom it was intended.

On 16 May 1998, in his annual message to the General Assembly, the president of MSF France reported in detail the challenges and dilemmas met by MSF in North Korea.

DOCUMENT

“President’s Annual Report,” Philippe Biberson, 16 May 1998 (in French).

Extract:

North Korea

This mission poses several problems, and I will try to explain why. Famine or no famine? Since 1995, North Korea has not been feeding all of its population. This is a fact. The collapse of its agricultural production combined with an end to the aid provided by ‘sympathetic countries’ has bought the country to its knees. Three years of natural disasters appear to have completed the catastrophe. It should be borne in mind that, in the North Korean system, the State, the cooperative or a production unit, including in rural areas, feeds the population. People are clothed, lodged, educated, treated etc. in the same way. Ordinary North Koreans don’t have the option of producing anything for themselves, or building up reserves. They are subjected to central planning and are completely dependant on what is redistributed. There is practically no money in circulation and practically no market.

Why draw attention to all its population? Because apparently, not everybody is suffering to the same degree. All populations contain marked variations in the individual capacity to resist deprivation and a lack of health care, and it is not really possible to specify which geographic areas and categories of the population in North Korea are at risk. Yet considering that this system is supposed to be equal, there are nonetheless some striking contradictions between what we see when we are moving around inside the country and what is described in the witness statements collected from people who have escaped it.

- From our work on the inside, we can see the country is in the grips of severe shortages but there are no indications of a classic famine: no people wandering about, no bodies, no riots at distribution points etc. We come across cases of malnutrition, often-serious ones, but only in the institutions we’re allowed to visit: hospitals, orphanages. The rest of the population seems to be going about its business.

- The testimonies collected in the area on the border with China, however, describe a nightmarish situation: decimated families, distributions stopped months ago – or even years ago – (and no traces of international aid), streams of people moving around in search of food, people dying of starvation, cold, disease, cases of cannibalism, traffic in women and children, crowds gathering at train stations, violence, repression and corruption.

As contradictory as these two images might seem, we believe that they nonetheless amount to two descriptions of the same country, North Korea, and we’re talking about its inhabitants in both of them. Famine is difficult to quantify, but it is likely, if not certain, that food and general shortages are affecting a large number of North Koreans, has killed some of them and continues to kill them still. What aid can we propose to the population of North Korea? For the first time, in 1995, the North Korean government called upon international aid, but fixed conditions whilst doing so: no evaluation of needs, no serious control over the destination of aid, selection and drastic discipline demanded of aid organisations. No opening up, no questioning of the system: a take it or leave it situation. Using a combination of persuasion, candour, high operational capacity and a volume of aid representing several million ECUs, Médecins Sans Frontières managed to set up a mission in North Korea, supplying the majority of medicines and specialised food needed for four provinces. Which is remarkable in itself, but we know that if we do not try and narrow the gap between our work and our intentions and place all this in context, we can go badly wrong.

Several questions need to be asked:

1. Does this aid save North Koreans or, rather, those dying of starvation and deprivation?

There are some real doubts. It saves a few, but we don’t have the means to know how many. Without wanting to get into cost/efficiency considerations, as you know as well as I do that we are not too keen on applying this criteria in humanitarian action, we nonetheless have to assume our responsibilities in this matter. How many deaths did we avoid in one year by providing aid evaluated at costing 50 million francs? It is currently impossible to reply to this question. In other words, we don’t know if this aid is loosening the famine’s stranglehold on those suffering from starvation or not. Moreover, because this aid does not give rise to questions on the cause of the disaster, we may be reinforcing the very system that starves and enslaves a part of the population.

2. Is the aid delivered by Médecins Sans Frontières an expression of solidarity and humanity with regards to those suffering so unjustly? Despite the devotion of the teams (and I want to be clear that they are not in question and deserve all our support), I regret to say that it is not, or at least not nearly enough. Because we are in a totalitarian country and because we are obliged to cover areas and a number of facilities that do not allow us to think otherwise. This was the government’s aim, of course: authorising us to spread out and distribute as much as possible without allowing us more than a few minutes contact with anybody anywhere. This aid is also an inadequate expression of our solidarity because until recently we haven’t known how to communicate in our own countries about the profound distress of the North Koreans and the nightmare their regime represents. And besides a few digs made by us and reciprocated by them, we haven’t known how to show our indignation to the North Korean authorities either.

3. Is the aid provided by Médecins Sans Frontières infringing upon our standards of quality, which is just one way of showing the respect we have for others? It is, unfortunately, with its mass coverage, little errors, and the approximations made here and there that are transformed into massive waste and large-scale inadequacies. That is how, if we are not extremely careful, a gesture of good will can be transformed, with volume helping the process along, into a gesture of condescension or even scorn.

4. Does the international community, or aid organisations to be more precise, have a responsibility in all this? Yes. Which is not to say that they are the ones causing North Koreans to suffer. That is obviously not the case. But their silence and their renouncement of agreed principles give this massive aid effort (which paradoxically might be insufficient) all the appearances of being a political compromise. There is a huge effort to make in terms of international aid given by states to answer the question: famine or no famine? On what scale? What caused it? And how can it be brought to an end? Everything indicates that the response to this last question resides exclusively in sending aid. And indeed perhaps no other policy is possible on an international level. But in that case, it should be explicit and held accountable. Why? Because such an option, whilst calling itself humanitarian, carries the risk of leaving people to die in the name of a ‘greater cause.’ We have seen this for ourselves in Eastern Zaire: the so-called eradication of genocidal nests in Kivu was well worth the sacrifice of some tens of thousand of refugees, according to certain strategies! And while we are on the subject, what eradication? In the case of North Korea, this greater cause could be called regional stability, even crisis prevention, and this policy would be known as a‘soft landing.’ We have to make sure that Médecins Sans Frontières is not part of a cover up for slaughter in the name of this so-called soft landing.

5. Over and above the North Koreans, but an important question nonetheless: is the work of NGOs being manipulated in certain contexts? Should their role not be:

1. To question and try to understand.

2. To bear witness on what they see and what is been said.

3. To take a position?

I say yes, and that’s what we’ve started to do, with no tangible results yet but we’re getting stuck into the issues that give us real credibility, and I invite other members of the Médecins Sans Frontières family to join us in this debate rather than set us apart. I am not one of those who thinks that Médecins Sans Frontières should never have set foot in North Korea. On the contrary, I congratulate the explorers who mapped out this mission in such hostile territory. And I can see how intelligent, sensitive and inspired they have been whilst running it. However, we are not happy with it. I remain critical as long as I have the impression that we are not asking enough questions. I am not looking to have us expelled, but I want us to fight for improved access to those dying of starvation and disease.

Once we have seen and heard all that we have seen and heard, what should we do next? In the case of Médecins Sans Frontières, it is not enough to be an honest bystander, as if we have accidentally found ourselves in a situation of witnessing something. In Médecins Sans Frontières, we deliberately place ourselves in situations that require understanding – and the opening of our eyes and ears – and then we say what we have seen and understood. If we do not follow this course, we are guilty of mere voyeurism right up to complicity in murder, depending on the circumstances. Bearing witness is also a consequence of choosing to place ourselves amongst people in distress.

MSF officials paid a round of visit to donors and aid actors. Several rounds of investigations were carried out among North Korean refugees in China and Russia. On 29 May 1998, the MSF France board discussed the strategy to be applied regarding the MSF presence in North Korea.

DOCUMENT

Minutes of the MSF France Board Meeting, 29 April 1998 (in French).

Extract:

Philippe Biberson: We’ve decided to meet all the people involved in aid in Korea to share our analysis, attempt to convince them, and ask them for their support. Eric Goemaere, Doris and I met Emma Bonino of the European Commission on the 25th May. She had gathered together some important people for the meeting, including Mr Navarro, director of ECHO. A European Union mission (parliamentary plus commission) had just returned from Korea. The main points of the report were: the famine seems to be over but ECHO needs to remain in the country. The situation requires evaluation after the forthcoming harvests; the focus should be on structural aid. We gave our analysis:

- The shortages are probably real, serious and not new. Contradictions exist between observations made inside the country and those on the Chinese border.

- Manipulation by the authorities: concealment alternating with information. Pseudo ‘opening up’, pseudo access.

- Aid is delivered blindly and contrary to all principles […] Concerns that this massive aid co-exists simultaneously with slaughter.

We presented the fragility of MSF’s situation (risk of being expelled, in a word). Our position and propositions concerning the form of our aid in the future (targeting and proximity) only gave rise to a letter of intimidation from the Korean authorities. The same intimidation is applied to all organisations. We requested ECHO’s support for this approach. The difficulties encountered by the different MSF sections in securing a common position should not become the subject of derision. We have the impression of being the only ones trying to have a global view of the problem and we are very uncomfortable with the mere role of aid providers.

Ms Bonino wondered whether she could pay a visit to Korea. She was well aware that she would be paraded around like everyone else; that she would end up making highly critical remarks, which she feared, could be counter-productive. She was lucid about her impotence. We drew attention to the importance of gathering all the information available and circulating it to the people involved. We suggested that ECHO should be able to obtain detailed information on food production and the economic crisis. Given that the blind delivery of aid is at the heart of the problem, there should be an active search to shed light on the issue. We didn’t have the impression that the EU has a real policy for Korea, other than being present. François Jean thinks that the EU should, on the contrary, have a detailed policy but E. Bonino was not the person to discuss it with.

Pierre: The American NGOs are ready to go to North Korea. Médecins du Monde shares our policy and the impression that the Koreans want to shut the door on European NGOs. As the offer of services exists, ‘humanitarian dumping’ could become rife. We need to arrange more visits to try and see what’s going on, try and gain information from surrounding countries, network in Japan etc. There are plans to return to the Chinese side and visit the border with Russia.

François B: How long do we have to wait before taking a clear decision? Even if we explain what’s going on in one board meeting after another, at some point we must draw up limits. We need an external view before July, how much progress can we make?

Jean-Hervé: We’re very pessimistic but we need to continue gathering information based on concrete action. Visits to China and the ex-USSR can be doubled with the help of a support network. Francois is working on Korea and we are planning on organising an international conference after the holiday period.

Xavier: Shouldn’t we be moving on this before July?

Jean-Hervé: Just moving on it won’t have much impact if we don’t back up our statements with more concrete elements...

Odysséas: The political outlook probably amounts to simply maintaining a presence in Korea without worrying about what happens to aid, that’s irrelevant. The humanitarian outlook must be different. We must check that the aid’s being useful, insist that it saves lives and we should not be scared of being expelled.

Rony Brauman: Humanitarian and political interests cannot be confused, but politics are often played off the cuff and seem to lack clarity.

INTERVIEW

We divided up tasks and I went with Eric Goemaere, the Executive Director of MSF Belgium, to meet the European Union representative in Brussels. I think it was because the European Union was giving massive funding to MSF and other NGOs over there. We had a meeting with Ms Bonino. Eric and I had made a good duo and we built up the picture so well that Bonino was really attentive. We shifted her opinion around completely. She had all her entourage around her, including Navarro who was following Korea. In reality, she knew little about the country, depending up until then on certain members of her staff who were specialists, who had been over there or who were managing the programme. In short, she received us with a mildly amused air, saying [Philippe imitates Emma Bonino and her accent to perfection], ‘so, which MSF is here today. The Dutch? The French? Which one? MSF’s in Korea, so which one is it? MSF International?’ She was playing with us a bit on this point. Whilst sipping her tea and nibbling her biscuits. But she wasn’t daft. It’s true that North Korea wasn’t her thing. That’s exactly what we wanted to say to her: that she was dumping millions of euros [ECUs] into a situation without having all the informationat hand. ‘So what’s the problem in North Korea?’ she asked us. The discussion began and she understood right away that we hadn’t come for fun, that whether the French, Belgian and Dutch sections of MSF agreed or not, we had things to say. Eric added his bit, and she started questioning her team, ‘are you aware of this? Who’s in charge? Is there a report on it? Well I certainly hadn’t understood things were like this!’ And we really laid it on thick.

She said, ‘oK, I’ve understood, and it’s outrageous. So what now? What should I do? Should I try and go there?’ So I told her, ‘it would be a very good idea to go, Madame. You have to go!’ And she said, ‘Yes, but if I go I’ll cause a scandal!’ At the time she was always kicking up trouble, in Afghanistan, Sierra Leone, saying, ‘why are things such a mess? It’s unacceptable, the European Union is going to do this, going to do that!’ I said to her, ‘yes I’m sure you’ll cause a scandal if you go because you’re not going to believe what the European Union is contributing to.’ She said, ‘is that so? Maybe it’s not such a good idea to go!’ We laughed a bit then, but I think that from that moment on, she understood. And within MSF, even if there was still huge reticence in the field – from Marie-Rose and maybe the Programme Manager in Brussels – Eric had no doubts at all.

Dr. Philippe Biberson, President MSF France, (in French).

INTERVIEW

The European Union has this strategy that was known by some as soft landing, meaning gradually changing the situation from within North Korea. MSF was against it. So we went to see Emma Bonino, to ask her straight out to impose more conditions on the European Union’s food aid. She said that she would take what we had to say into account. Unfortunately she had also asked the EU’s local representative for North Korea to attend, the one who usually dealt with MSF in the field. Obviously he defended his corner, saying there was no problem; he controlled all the aid being delivered. For me, there was no contradiction, we were using EU funding and trying to apply international criteria: direct access and control of distribution. It should also be borne in mind that the funding we received from the EU represented a tiny amount compared to the overall amount given in international aid. It was outrageous. The WFP’s biggest food operation in history was in North Korea.

Dr. Eric Goemaere, Executive Director MSF Belgium (in French).

On 9 June 1998, the MSF France Foundation dedicated its monthly conference debate to the question of the famine in North Korea. Researchers and expatriates who had lived in North Korea discussed the issue with MSFers and some journalists. In the field, the team was encountering increasing difficulties in gaining access to the most vulnerable populations. François Jean, carried on his researching work on the structural causes of the food shortages in North Korea and on North Korean Refugees.

DOCUMENT

Email from François Jean, Research Director, MSF France Foundation, to Barney Ruben, Researcher, 5 May 1998 (in French).

Extract:

Dear Barney,

I’ve started working on North Korea – or rather started doing some initial groundwork – and at first glance -- there are very few serious studies of the situation around. The contrary would have been surprising: the country is pretty impenetrable [… ] Nonetheless I’ve collected the names of a few researchers:

- Nicholas Eberstadt, American Enterprise Institute

- Marcus Noland, Institute of International Economics

- Scott Snyder and Stanley Roh, United States Institute for Peace

- Stephen Linton, Center for Korean Research, Columbia University

If you have contact information for these institutions, could you send them to me? And could you let me know if you’ve heard of other researchers, research centres, or even journalists working on this subject (the nature of the regime, the way society is run, its agricultural policies, the food situation, etc.)? I think that the only way forward, at this stage, is getting in touch with Korea watchers working in the United States, the Korean Republic or other countries. Thanks in advance for any information and suggestions you can send me. Speak to you soon.Take care,

François

DOCUMENT

”Famine in Korea? The History, the Issues at Stake and the Problems,” Invitation, MSF France Foundation, 9 June 1998 (in French).

DOCUMENT

”Korea,” Email from Philippe Biberson, President MSF France, to François Jean, Director of Research, MSF Foundation, Pierre Salignon, MSF France Programme Manager, and Sophie Delaunay, Epicentre, 12 June 1998 (in French).

Extract:

Just a reminder for all three of you. If there’s a research trip organised to South Korea this summer, it’s imperative to take up contact with the people on the Seoul Peace Prize committee. I’ve just had a very interesting conversation with its president, Mr Lee Chul-Seung. He’s very critical of the international humanitarian community’s attitude and particularly the Americans = Clinton. He says that history will eventually reveal that this flood of aid was poured blindly into a country that violates human rights on a daily basis, etc…

DOCUMENT

Minutes of the MSF France Board of Directors’ Meeting, 19 April/June 1998 (in French).

Extract:

Pierre Salignon described the progress being made on the various fronts. François Jean has left for Moscow to identify two persons to work with MSF on the collection of information. There’s a plan to visit the region bordering with Korea in July or August. Sophie Delaunay and François are currently preparing a visit to South Korea to meet with various people in July. They would like to take the time to assess these people as there are numerous researchers working on North Korea. We’re starting to build up a little network, which provides us with a fair amount of information. At the same time, when he gets back from Moscow, François Jean should go to the United States to prepare for a meeting in October with the people involved, to find out who thinks what, particularly the American and European NGOs etc.

In the field, we are currently battling with a problem of visas and limitations on the number of expatriates. Médecins du Monde, which is still in the negotiations phase, will stop in June. For MSF, there’s a potential problem in the North. In this latest province we’ve become involved in, the whole population was called up to work in the fields in February 1998, which poses a problem for visiting the hospitals, there are very few people are around. Marie-Rose, the coordinator, will visit the province to see what’s going on. William Péréa says that things are becoming more and more unacceptable there. We could decide to stop our work altogether but we need to collect more information first. We’ll see how things go with the negotiations but a deadline has been drawn up for July/August.

The Foundation organised a conference on North Korea, with Pierre Rigoulot and P. Biberson. It allowed us to increase the circle of people we can question about the nature and pertinence of aid in North Korea. The conference was followed by a debate and allowed us to meet people familiar with Korea, especially one person who spent a year in Pyongyang as a teacher. She had really interesting things to say. She’s still got friends there, and didn’t want to put them at risk by saying too much. But her contribution made a strong impression on us. She lived in a wealthy environment, amongst teachers, and was constantly watched over and surrounded by people, drivers, translators etc. She realised right away that people were hungry. The best thing she could do to give them some relief, help them out, was to spend part of her monthly salary organising meals at her home. She gave us a lot of information on the underground system set up by the people, which is witness to the total shortage of food and everything else, access to health care, hospitals, medicines, and an open form of corruption. Access to a doctor, which should be fairly straightforward, has to be paid for with a carton of cigarettes, etc. People were reluctant to talk about the situation, but she soon understood what a nightmare their lives were. And she left North Korea in December, so fairly recently.

Pierre Salignon: her words chilled us to the bone and confirmed everything we’d heard in the refugee camps. Her analysis of the system, the mode of social stratification, was telling. People received 100 grams of food in Pyongyang. The aid system and aid distribution posed problems.

DOCUMENT

Monthly Report, MSF DPRK, June 1998 (in English).

Extract:

It is felt that the general situation in the country improved with continuous inflow of food and medicines. It is however possible that situation will worsen again during the lean period of July and August. Despite the improvements in the situation in the country and the prospect of more active involvement of the international community in agricultural recovery, the international relief organisations present in the country have started to experience new and increased restrictions on the implementation of their programmes with the possibility of more limited operating conditions on their future activities. [...]

The nutritional survey is still on the table, talks are being held with the implementing partners about the protocol to follow, but little information is given to the NGO’s. It seems that UNICEF will be the major counterpart for the authorities to handle the survey. The delegate from ECHO left temporarily the country (?), the WFP head (Douglas Coutts) left as well, and also Dr Omawale will leave in August they say, so who will follow up this matter? UNICEF: the poor functioning of UNICEF was also mentioned in the report of the EU delegation visiting the country in May. To continue the trouble: 3 international staff members (all Norwegian) resigned: the medical co-ordinator, a supply officer and a water-sanitation expert. No reason was given, just the assurance that they will be replaced ASAP. A programme will be set up to assist the production of ORS in the country. The country asks more and more raw material to be imported instead of drugs. UNICEF can only assist in the production of ORS as stated in their mandate. For the next three months UNICEF guarantees us a monthly supply of 15 MT of HEM for the feeding centres in the three southern provinces. UNICEF received the demand for funding the printing of the Korean translation of the MSF nutritional guidelines. Nobody was aware that this guideline was under translation. UNICEF asks MSF for authorisation.

MDM: The surgical program in South Hamgyong province was put to an end earlier than planned. The team found the working conditions no longer acceptable: no access to the patients before and after the operations, difficulties with the translations of technical terms, the low level of knowledge and operation techniques used are so archaic that further collaboration was impossible. The drugs programme continues until the end of the month and by the first week of July the whole MDM team will have left the country. [...]

North Hamgyong Province

The working conditions for the team in Chongjin did not improve this month, with the excuse of the planting season, travelling to the different hospitals was restricted: only one county per day, the members of the team have to stay together. This is diminishing the efficiency of the program as the hospitals can only be visited once a month and travelling time makes the visits rather short. As we have now doctors in this province the situation will have to improve, the doctors should be able to travel in different directions otherwise it does not make much sense to have a second doctor. Discussions about the plans with the provincial and central authorities resulted in the changing of one of the translators (he should have better explained the conditions of the country). This situation improved after the visit of Marie Rose to Chongjin, during some days in the week the provincial FDRC is willing to accept the team to go in different directions. Also the living conditions for the team are difficult: walking into town is limited, use of bicycle only permitted outside town and always accompanied by translators. The team stays there during six weeks before coming to Pyongyang. [...]

North Hwangae Province [...]

Stock keeping in most places ‘correct’, but unreliable... The local authorities more and more give information that drugs are saved and stored for later (many hospitals expect us to leave soon, “we would be here for one year only...”). Very difficult to change, especially when our kits are delayed.

Morbidity

Morbidity forms collection is a ‘prayer without end.’ The concept just does not work: in some clinics it turns out they have special morbidity recording for patients treated with our drugs, in other hospitals, they add the ‘second line’ treated patients, and overall, the collection is very slow (months behind). My idea is to concentrate on a different way of data collection (files/ward administration) and insist on access to these in the MoU. [...]

South Pyongyan Province

[...] Monitoring

Discussion with the counter parts about the distribution plans: it is clear that these have not been respected:

- Redistribution of the kits on equitable base: 450 kits were sent to the off-limit counties

- Distribution lists provided by the authorities did not reflect the reality: some facilities were not included, and for the very small ones, no drugs were given. The county and provincial authorities adapted the distribution plans accordingly; also some provincial hospitals not included initially received some kits. The authorities are reluctant to give us an updated list of health facilities. Therefore we decided to ask the county directors to present the distribution plan of their county. This is evaluated through field visits and seems to be done quite correctly. The health structures were more freely accessible using this distribution system.

INTERVIEW

During the Foundation’s conference, we met this woman, V… who’d been an interpreter in Pyongyang for a year. She told us that she was certain there was cannibalism in North Korea, even in the upper social classes. She was an interpreter in Chinese and Korean and had been living in China for a while. She did an interim in Pyongyang, replacing an old French interpreter who was seriously ill. All the regime’s propaganda was written by interpreters who settled over there years ago and are completely enslaved to the cause, totally besotted with the Koreans etc. The old interpreter was too sick to return to Korea. So V…. ended up staying in Pyongyang for a year. She became very close to her colleagues. And she told us, ‘I sometimes invited them to tea in my rooms, in the tower blocks where the interpreters lived, but I soon realised it wasn’t the tea that interested them, but the sugar and butter. They ate them by the spoonful. Once I’d realised that, I often invited them home. We put the tea to one side and I made them toast with butter and sugar.’ One of her colleagues told her that he was invited to the funeral of a member of his close circle but he didn’t want to go because he knew that at funerals they ate meat. [meaning cannibalism ?…]

Dr. Philippe Biberson, President MSF France, (in French).

On 14 June 1998, WFP and FAO representatives returned from a visit to North Korea and announced that the food situation in the country remained precarious and that the food crisis was not over. They reported that the North Korean authorities were not distributing the entire food stocks and were saving some of them in case of possible shortages. www.video.13

DOCUMENT

”Precarious Food Situation in North Korea, According to FAO and WFP,” AFP (France), Beijing 14 June 1998 (in French).

Extract:

The food situation in North Korea remains ‘precarious’ and the months of July and August will be ‘critical’ for the population, the two UN organisations in charge of food indicated in Beijing last Sunday. “The food situation remains precarious. We have travelled all over the country and we can say that the food crisis is not over,” declared Abdur Rashid, Head of Mission for the Food and Agricultural Organisation (FAO) and the World Food Programme (WFP) in North Korea. “We are particularly concerned about the two next months which are critical, because food stocks are almost exhausted and the public distribution system hasn’t been working since last March in many parts of the country”, he added during a press conference at the end of a ten-day trip in the country. Before the food distribution system came to a stop, rations had been reduced to 100 grams per day per adult, whilst the normal need is 450 grams. According to Mr Rashid, the authorities have apparently chosen to put the stocks of international food aid to one side for distribution in the event of the shortage worsening. Even if the harvests “seem generally satisfying, the perspectives for the rest of the year remain ‘uncertain’ before July and August, the two main rainy months of the year” declared Mr Rashid. [...]

For his part, Douglas Coutts, the UN’s humanitarian coordinator in North Korea, refuses to confirm information that the famine raging in the world’s last Stalinist bastion has led to several million victims. “People aren’t dying in the streets. They’re dying of diseases which would normally have been easy to treat had they been eating enough,” he explained. According to him, the inhabitants have been reduced to “picking grass in the parks of Pyongyang for the preparation of green-coloured biscuits” which has become “the main form of nourishment for most people, despite their lack of nutritional value.”

The food shortages have provoked a rise in pneumonia and chronic diarrhoea, above all in children. In the countryside, the representatives of international organisations have observed a quasi-total absence of running water and heating during the winter, even when temperatures drop to less than 20 degrees during the day. “People are obliged to do their washing in the rivers”, he said. Mr Rashid considers that Pyongyang is confronted with a “major deficit” in international food aid. Last October the FAO and WFP evaluated that 1.95 million tonnes were needed for the period of November 1997 to October 1998, but only 400,000 tonnes were sent, with another 400,000 expected. […]

According to certain information, the famine in North Korea has caused at least a million victims over the last few years. The organisation Médecins Sans Frontières talks about cannibalism and states that international aid is diverted to the military and senior ranks of the regime. The two Koreas did not manage to agree about the dispatch of fertiliser from the South to the North during discussions organised last April in Beijing.

DOCUMENT

”North Korea Famine – Remarks,” Email from Pierre Salignon, MSF France Programme Manager to the North Korea network, MSF Belgium, MSF Holland, MSF United States, 15 June (in French).

Extract:

I’m taking the liberty of sending you this dispatch in order for you to question your WFP and FAO contacts for more details on these declarations. Maybe there’s a mission report in circulation? Catherine, could you get more info in NY if you can? As you can see, there are several troubling remarks about the aid distribution system in North Korea and the current situation:

- The conclusion for the FAO and WFP mission: the situation still remains ‘critical’ for the FAO and WFP… (indicators? direct observations?) […] “The public distribution system hasn’t been working since last March in many parts of the country.” We’ve heard about this from refugees on the border, but it’s the first time we’ve heard it from a UN representative. They go further still, “the authorities have apparently chosen to put the stocks of international food aid to one side for distribution in the event of the shortage worsening.” Is this a recent WFP discovery? A half-acknowledgement of the diversion of food aid? We can ask ourselves, and them, the question. […]

-3 Other troubling remarks/observations, which need follow up in Pyongyang and NY/Geneva:

(1) “The lack of fertiliser, machinery, and sources of energy oblige school children to work in the fields, cultivating land”…

(2) “The rations had been reduced to 100 grams per day per adult. According to the FAO, the authorities have apparently chosen to put the stocks of international food aid to one side for distributing in the event of the shortage worsening….”

(3) “The inhabitants have been reduced to picking grass in the parks of Pyongyang for the preparation of green-coloured biscuits which have become the main form of nourishment for most people, despite their lack of nutritional value”…

Without second-guessing why such declarations are being made by the WFP and FAO (their annual appeal provoked little response), we should once again note how much their tune has changed from a few months ago, when the WFP was rejoicing in the ‘efficiency’ of its aid, which staved off a catastrophe... These recent declarations raise huge questions, which we should put to them directly.

In June, most NGOs, including MSF, encountered increasing difficulties conducting their work and in gaining access to the populations in need. In mid-June, MDM (Médecins du Monde) did not succeed in signing a new MoU. They were the first of a string of NGOs, which would later leave North Korea. The North Korean authorities announced to MDM that in the future, they would rather import raw materials to produce medicines locally rather than rely on NGOs.

DOCUMENT

Memo from Marie-Rose Pecchio, Coordinator MSF DPRK, to William Claus, MSF Belgium programme manager, June 1998 (in French).

Extract:

Here’s the news I received last night in the Pyongyang social club. Some of it is rumour, other bits are official […] Rumour has it that the authorities don’t want to let people stay here too long because they acquire too much knowledge on how things work. So the ‘old timers’ are in the process of leaving. Douglas Court – 1 year, the number 2 of WFP, John Proud – 2 years, the Swiss Disaster Relief representative – 2 years, Omawale – 1 year, UNICEF

3. MDM: it’s not very clear what’s going on. The HoM has started negotiating with the FDRC. They’ve talked about money and the length of the programme, but not yet about the programme itself. There were two visits from headquarters in May to launch the idea of new projects. The FDRC doesn’t know yet if it’s yes or no. The reason: MDM started its project very late, so it’s not reliable. But, the FDRC will see. In short, nothing’s definitive yet. According to the anaesthetist who was on mission here for a month, their headquarters is ready to make concessions in order to stay. Which is a bit contradictory with Paris’ information, isn’t it? Remarks on the anaesthetist + surgeon’s mission – their month in the field was worse than awful. They could help with interventions but weren’t allowed to see patients before and after. Techniques date from before the 1960s; rules of hygiene and asepsis are non-existent, and the reasons for operating were very unclear. In short, very very dangerous. They have some regrets about introducing general anaesthesia […], which makes me very happy we’re not doing surgery and that Ton didn’t distribute ketamine. […] They can’t get a visa for someone from headquarters to come and discuss how the programmes should continue.

4. ACF: their work’s completely blocked: they still haven’t received the list of children in the nurseries. No list, no distribution. In addition, the 2 nurses are obliged to move around together, like us, in fact. To cut it short, the Coordinator has gone back to Paris for discussions […]

7. The Red Cross has decided to stop food distributions since an evaluation carried out last April. Massive outcry from the local Red Cross and the authorities. The representative pleaded with Geneva to change its mind, offering a kind of food basket study carried out with certain beneficiaries chosen by the local Red Cross as proof. [...] While Geneva’s making up its mind on this food issue, no visas for headquarters staff have been issued.

8. Thing’s aren’t looking any better for us: In Chondjin, all 3 team members are obliged to move around together until the planting season is over. 2 doctors in the same hospital for counting boxes are a bit excessive. They can’t leave the hotel, even accompanied. Gunter’s at the end of his tether with this ‘village doctors’ thing. Planning for visits to all provinces has to be handed in on the preceding Tuesday instead of Friday. […] I have the feeling that the situation’s gradually going down hill. In my opinion, they’re putting up more and more obstacles so we get so fed up and leave. Me and the team here have this impression, as do other expats. […] Some TFCs have no children. What about the option we selected: shutting if there are no children? It seems logical, no??

DOCUMENT

”MDM,” Email from Marie-Rose Pecchio, MSF Coordinator DPRK to William Claus and Patrick de Briey, MSF Belgium Programme Managers and Marie-Christine Ferir, MSF Belgium, Director of operations, 17 June 1998 (in French).

Extract:

Hello,

OK, it’s settled, MDM’s leaving. They can’t have a new MoU. There’s no written notification, but they were told in person during a meeting with the FDRC. The reasons:

-In the future, Korea prefers to import the basic materials required for manufacturing medicines rather than bringing in medicines via NGOs.

-MDM is a bit lightweight: it signed its MoU in September but the programme only started in January. ECHO only signed the contract in January.

People from the Paris headquarters are not authorised to come. They can stay until the 10-15 July to monitor the 72 tonnes of medicines that have already arrived and then that’s it. That’s all I have to report, though it’s sure that other NGOs will follow (CAD, Helpage).

Marie-Rose

In July and August 1998, as the MoU signed earlier was running out, MSF carried out negotiations with the DPRK authorities regarding the possible future of the MSF project in North Korea. One of the issues was the potential for MSF to have access to the socially deprived children identified by the volunteers, whom they suspected to be orphaned street children. When preparing the negotiations, MSF discovered that these children were earmarked as 27/09 - in reference to a Kim Il-Sung decree regarding people classified as ‘rejected by the society.’ They prepared a report about these ‘socially deprived children’ that was circulated to the authorities and to the aid agencies and donors present in North Korea from 11 September 1998. MSF’s objective was to convince the humanitarian organisations that were remaining in the country to follow up on on the plight of these children.

DOCUMENT

“Identification of an ‘At Risk Group: Socially Deprived Children’,” Letter from Marie-Rose Pecchio, Coordinator MSF DPRK and Report, to UNICEF, WFP, FALU, UNDP, OCHA, WHO, DG8, ECHO, IFRC, SDR, CAD, Concern, ACF, Cap Anamur, OXFAM, Cesvi, USA PVO Consortium, GAA, 11 September 1998 (in English).

Extract:

Please find enclosed a report made after one year of field visits by the MSF teams. This report is about an important issue, some specific groups of children, and has been given to the authorities and discussed with them. Our main concern is the health of the children and therefore we want to share this information with the humanitarian organisations still present in the country, so they can continue a follow up and assist the authorities in finding solutions. As MSF is leaving the country, we will not have the opportunity to develop further activities in that direction. By no means was this report meant to criticise the authorities or political system of this country and the information given should not be interpreted as such. We are sure that all the information organisations will feel concerned by this problem and will find a humanitarian solution.

Report:

Identification of an at risk group: socially deprived children

MSF came to the DPRK with a double programme: the distribution of drugs in four provinces and the implementation of therapeutic feeding centres in the same provinces. These two activities were carried out between July 1997 and September 1998. After one year of the programme, it is possible to make some observations about the nutritional programme. The feeding centres have been organised in all the counties where we were allowed to work. In general the centres functioned well technically as the Korean medical staff understood quickly the new methods of diagnosis of malnutrition and also the specific curative protocols.

However:

- The number of children admitted to the centres is relatively low: the number of admissions under five does not exceed 1% of the under five population (estimated at 10% of the general population).

- We still have no idea how representative are these children treated in the centres. Are they all the malnourished children of the county or only part of them?

These are the major reasons why we decided to put an end to the nutritional programme, even before the end of the actual MoU, and discussions [are] still going on for a next one. It is quite clear that MSF will not be able to conduct a nutritional survey, not even in the counties where we work. We are therefore not able to evaluate the nutritional status of the population (is there still acute malnutrition and which age group is most affected?) and at the same time we are not able to evaluate the current programme (is this kind of feeding centre a possible solution for the nutritional problem?). Another important factor in the decision to close the feeding centres was that in many hospitals we noticed that our confidence [trust] was abused: admission criteria were on purpose [intentionally] not respected, and many ‘fake malnourished’ were added in the registers only to increase the theoretical daily consumption of milk. Are these quantities of milk retained, constituting a stock for when the programme will be finished? Was this extra milk given to other children? Was the milk given to children who did not need it? On the other hand we found, among the children admitted in the feeding centres, a specific group of children who more urgently needed our help. With all the observations we made we can say that they do not only have a nutritional problem, which is often very serious, but also clear social problems.

MSF is a medical organisation, which works closely with the population and insists that the aid it brings will go to the most vulnerable ones. We have doubts that this was the case here.

We asked repeatedly for access to these children from the different authorities so we could help them and solve their problems at ground level. The local and provincial health authorities more or less admit the need for intervention and even more, the difficulty to reach these children. The central authorities simply deny their existence. We do not understand why such a wall of silence is being erected around these children, maybe it is only because for the Koreans it is difficult to admit that certain things do not function as they should, which is not surprising taking into account the difficulties they had after several years of natural disasters. At the same time we noticed that important efforts were made by the health authorities to take care of these children. Certain centres put a lot of energy in them and we were impressed by the will of many Korean paediatricians to assist these children. But now we think that it is time to go a little bit further and try to solve the problem at a higher level, if possible. At the present time we can only put a plaster on a gaping wound, as we have no possibility to treat the problem at its source.

The nutritional rehabilitation centres of Pyongsong

It is through the nutritional rehabilitation centres that we were able to gather most of the information concerning the socially deprived children. It is very likely that these centres were not an important factor in solving the nutritional problem of the country, they did not give us a clearer idea about the nutritional status of the children either, but they allowed us to identify certain specific problems that we probably would not have noticed otherwise. Two Nutritional Rehabilitation Centres (NRCs) are particularly interesting: the one of the city hospital of Pyongsong and the one of the provincial paediatric hospital, also located in Pyongsong. The number of children treated there is rather important (613 admissions in 9 months, in the two hospitals, children under and above five years old) but more important is the fact that the population of children seen in these centres present some common characteristics that we hardly find in other centres of the province.

A. History

Until the middle of November 1997 the paediatric hospital seemed to function normally, at least that’ what it looked like. We paid relatively few visits to this hospital as the programme focused more on the health facilities of a lower level, the county hospitals. However, as the provincial hospital is the referral structure, it served twice as a meeting place for the paediatricians’ training course about malnourished children. The first course took place at end of July and was given for the paediatricians of the hospital by Dr Egil Sorensen of UNICEF in the presence of Brigitte Noel, the MSF nurse. During these two days of training a group of about twenty severely malnourished children were present for the clinical demonstrations. While waiting in the morning to enter the hospital, Brigitte and Dr Sorensen were very surprised to see two children in bad general condition that were driven away in a cart to an unknown destination. No reasonable explanation could be given by the staff. During a regular visit made two days later we were not able to trace one single child present during the training, they were obviously brought there for the clinical demonstrations.

A second course was given in this hospital, by MSF, to all the responsible paediatricians of the province. This course took only one day and we could not see these children. Also during the next two regular visits made by Brigitte nothing special could be noticed, there were some malnourished children in the ward but nothing special. William Claus, responsible of the MSF-Korea programme in Brussels, visited the paediatric hospital in October. Severe malnourished children were presented to him, but during the whole visit we had the impression that things were set up. This suspicion was confirmed a few days later during an unexpected visit by Brigitte: none of the children shown to William could be found in the hospital, and again no valid explanation for this fact could be given. After this incident we paid no further visits during several weeks and put more effort in the other centres in the province.

It was only on the 21st November that Brigitte returned there for a regular supervision visit. She noticed however that there were no malnourished children at all in the wards she usually visited. She was informed that they were placed in another building, where at first she was not allowed to enter, but as she insisted, the hospital director finally gave his permission. She saw, in this building, about thirty children in a very bad general condition, physical, medical as well as nutritional. They were grouped together in the corner of a poorly heated room. They all suffered from severe malnutrition and some of them were too weak to stand up. From this moment on we decided to hold on to these children and organised weekly visits to make sure that they received at least basic care. To our surprise this was the beginning of an influx of children all presenting similar characteristics. In the city hospital, located at about five hundred metres from the provincial one, the paediatric ward and the nutritional centre were opened only in October after the rehabilitation works were finished. Initially the children admitted were as in the other centres throughout the province. Only at the end of the winter it became apparent that the hospitalised children belonged to the same group as those in the provincial paediatric hospital. They presented the same characteristics.

B. General impressions

-The age distribution is completely different from what we observed in the other feeding centres. In general the under five’s are the majority (average 4.1 years) but here we have mainly the above five’s (average 8.8 years). The provincial hospital has even older children (average 9.9 years) than the city hospital (average 7.4 years).

-The sex distribution is more in favour of boys (61%) than in other centres (53%). This is not due to the different age groups: for the children aged 6 to 18 years we find 43% boys in regular centres and 62% in Pyongsong (67% in the paediatric hospital, 54% in the city hospital).

- The exit of these children is remarkable and seems to be somehow regulated instead of at random. We made two important observations:

* Daily a few children are being discharged from the centres. But next to that there are more or less regularly groups of children leaving the same day (up to 12 on one day).

* These grouped exits happen sometimes on the very same day in the two hospitals, which is surprising for two facilities supposedly working independently.

- We noticed the absence of parents and other family members. Also in other centres the bigger children are often not accompanied by relatives, but during eight months of weekly visits we never noticed one relative in the ward, except the mothers of young malnourished children who were kept in separate rooms.

-There is an almost total absence of personal belongings, except a few small things or a book from the hospital library.

B. Common characteristics of the children

1. General condition:

Upon their arrival the poor hygiene of their bodies and clothes is not found in the general Korean population. Their clothes are dirty and in poor state.

2. Nutritional status:

- The majority of the malnourished children are severe cases (often kwashiorkor), which is in contrast to the observations in the other centres where we see mainly moderate cases of marasmus (even taking into account the more or less voluntary manipulations of the statistics).

-The mortality is higher than in other centres: 3% in the city hospital centre, 3.8% in the provincial centre and 0.3% in the other centres. This is probably due to the serious condition they present at admission.

-Some cases of deficiencies have been diagnosed: many have anaemia, some cases of pellagra and one case of scurvy.

3. Skin diseases:

-Almost all children have scabies often complicated by bacterial infection on the hands resulting in inflammatory oedema.

-Many have abscesses or scars from healed abscesses, mainly on the scalp. The ears are very often infected, marked by a moist inflammation on the ear lobe.

-Lice are very common and were present in all children during the month of February. Many children admitted have their heads shaved.

- Some children have a suntan, they present with less skin disorders.

4. Psychological status:

Some children are very absent-minded: fixed look, absence of emotional reactions, even after nutritional recuperation.

5. Other problems:

- Some cases of frostbite on the feet with amputation of toes have been seen.

- Certain children are suspected tuberculosis cases.

- The prevalence of diarrhoea is important during the whole year, also respiratory tract infections are often noticed but with a seasonal pattern.

These are only impressions; we were denied access to the medical files of the children.

D. Origin of the children

It is not clear where these children come from. There are several possibilities:

-The general and sanitary condition of the children of Pyongsong indicates that they lived in precarious conditions for a certain time. It is important to remark that along the streets, in other hospitals and in the institutions visited in the province we did not see these kinds of children.

-The general presence of scabies and lice are signs of overcrowding that might indicate that at least some of these children come from institutions. At the present time the only institutions we know of are the orphanages.

Many of the children are undoubtedly street children, a fact recently accepted by some local authorities. Some of the TFCs have surely (and they admit this) accepted street children; others did not as they judged the problem as too big to be handled by them, others deny their existence. Also not to exclude is the possibility that some of these children come from the listed institutions but the worst cases were never shown on the regular visits: many children in Kilju boarding school could be in this category. [...]

4. Conclusions:

- The orphans that we were able to see do not correspond with those admitted in Pyongsong. None of them had skin problems similar to those observed in the two hospitals.

- The orphans not taken care of by the authorities (? number) and the children abandoned by their parents have to be somewhere, or in an institution under the responsibility of the county, or with individual families, or outside in the nature... It is unclear where they go to once they leave the institutions for the babies.

- The numbers of orphans who are in the official institutions are less than the number of children treated in the NRC.

F. The future of the children in the feeding centres

At present time we do not know their destination and do not receive a clear explanation about this. This is not very encouraging but strengthens the idea that they belong to a special category of the population. A probability is that they return to special institutions. The presentation of these children at the beginning of our programme (during the course of UNICEF and the visit of William) might indicate that this institution is located near the provincial hospital. Also the fact that we had some re-admissions points in the same direction. However it is very difficult to understand what really happens.

Conclusions.

- MSF worked for one year with the Korean malnourished children. One of the conclusions is that it is very difficult to have a clear picture about the nutritional status of the population. This will stay like this until a serious nutritional survey can be carried out.

- In the feeding centres we clearly identified a population of children in a very bad nutritional state and with characteristics that indicate that they live in difficult social conditions.

- Through these observations we think that besides the institutions officially listed, there is or are other institutions where children of different origin stay.

- We hope that after our departure efforts will be made to find a solution for this humanitarian problem of socially deprived children, and this in collaboration with the Korean authorities. In this case the work of the Korean doctors for these children will not have been in vain.

INTERVIEW

There were negotiations for renewing the contract at the end of the first year. I don’t really know what happened at headquarters level, which decisions were taken, but during the discussions we had with the authorities, we had a mandate for the second year to try and get official access to children. As a reward, we would continue to supply medicines. Our condition for staying was the development of a nutritional programme for children. Whilst preparing for the negotiations, we collected information from a variety of sources to identify where we could set up this programme, in which centres and on what scale. That was when we realised that they used an abbreviation in their registers, which was often applied to the children in the worst states. We realised that these children were being classified in a particular way. They probably had no parents and they had a kind of registration number, shared by them all, 27-9. We found out later what this stood for. 27-9 corresponds to the date of a decree made by Kim-II-Sung concerning the reassertion of control over elements living outside society; street children. Every time we saw this date, it was applied to a child in really bad shape, who probably came from an institution for street children, and who had been mistreated. Those in the worst state were sent to nutritional centres.

In reality, it wasn’t easy to see street children. We caught glimpses of them from time to time, they were mostly concentrated at specific points like train stations. Outside the capital, the Action Against Hunger volunteers sights, groups of 30-40 children walking around at night. What was strange was that in the other provinces, the teams almost never saw these children. Yet when we pushed the authorities a bit, it was really obvious. We never managed to know what became of them once they’d left our nutritional centre. We never had proof of what happened afterwards, where they ended up. Did they go back to the streets or return to institutions? We discussed amongst ourselves whether we should try and follow them up or not. We were pretty much in favour of trying, because it was obvious that most of them came from the streets, not institutions, and were going back to the streets too.

Dominique Lafontaine, physician, MSF Programme in DPRK, August 1997 to September 1998 (in French).

INTERVIEW

They arrived at the hospital, in the paediatrics department, in groups but not of their own accord. We think they were street children who’d been gathered up by the authorities and put into certain centres, for which no one took responsibility. Neither UNICEF nor anyone else had access to these children because officially they didn’t exist. The authorities said that they didn’t exist. We were ready to take care of them. We proposed an additional element to our programme, without taking money from elsewhere because the authorities were really sticklers about that. We proposed to take care of them; going to the source of the problem, i.e. to the orphanages that we suspected existed. There were special orphanages for these ‘non-existent’ children who in fact came from the street, whose parents were dead or in prison, and who had been abandoned by the regime.

Marie-Rose Pecchio, Coordinator MSF DPRK, December 1997 to September 1998 (in French).

INTERVIEW

I was amazed by the naivety we displayed in using the term ‘street children.’ It was like the game ‘spot the odd one out’: you have twelve African animals and in the middle of them a fox and a wolf and you’re asked to ‘spot that doesn’t belong.’Talking about‘street children’ in Korea where everything was clinically clean, organised, manically ordered; was ludicrous. How come these children were allowed to wander about? And if it wasn’t allowed, who was regrouping them in the train stations, what was going on? For me, using the term ‘street children’ in North Korea had far more repercussions that when referring to street children in Cairo, Bangkok, or Guatemala. It was a way of trivialising a symptom that was nonetheless totally unbelievable: if there were street children in North Korea, it was because the regime had lost control. People could move about, wander around, leave their areas of production and residence when normally the smallest little trip required papers and everything was organised beforehand. This helped us believe in something that we hadn’t really seen for ourselves, but the refugees had told us about, the researchers had described for us: people started crossing the border. But it nonetheless made us think about what we’d seen.

After some reflections, we recalled that in this clinically clean, pathologically ordered country, we had seen people on the roads. We thought they were with broken down trucks but when we went back over it, we recalled that on certain roads there were sometimes people brandishing cartons of cigarettes. Our interpreters couldn’t explain what was going on, but we told ourselves: ‘there are nonetheless some people moving around, taking to the roads. Maybe they’re broken down trucks, or military who’ve stopped to bargain for taking a few people in their trucks to make a bit on the side, etc.’ We started saying to ourselves that it wasn’t just a theatre of shadows, built up to impress foreigners or keep certain things secret, but we were in the middle of a nightmare. The penny had to drop at some point.

Dr. Philippe Biberson, President MSF France, (in French).

INTERVIEW

In my opinion it was our stirring up of the street children issue that bothered the authorities the most. The doctor and nurse in the team who’d identified the children in question were very concerned. For them, if they didn’t have access to these children, they were doing nothing of any use. They were sad to leave; they saw it as a failure. But we certainly weren’t ready to stay at any price. This struggle for access was exhausting.

Dr. Eric Goemaere, Executive diector, MSF Belgium (en français).

The negotiations about the possible new MoU were fuelled by various discussions held within MSF. On 20 and 21 July 1998, the whole MSF team in North Korea had a meeting in Pyongyang to discuss the achievements and the prospects of the programme. On 24 July, MSF received a one-month extension on the MoU. On 29 July, a MSF Holland group recommended that MSF continue to try and gain access to the vulnerable North Korean population and to define a threshold, which would indicate the right moment to leave. On 10 August the MSF Coordinator in Pyongyang proposed a plan to close the mission. On 13 August 1998, during an inter-Programme Managers meeting, the three MSF sections (France, Belgium and Holland) involved in North Korea formally agreed to close the DPRK mission at the end of the current MoU.

DOCUMENT

Minutes of the meeting of MSF DPRK in Pyongyang, 20 and 21 July 1998 (in English).

Extract:

What have we achieved in the programme after one year?

DOCUMENT

“Discussion Paper or Reflection on the Coming Negotiations With the DPRK,” Memo from William Claus, MSF Belgium programme manager, 23 July 1998 (in English).

Extract:

Major constraints:

-Difficult/no access to the population (window consultation)

-Small number of expats on the field compared to the magnitude of the programme.

-No access to data or data biased in function to the delivered amount.

-No means of evaluation, especially for the nut programme.

-Collaboration with the authorities difficult.

-Freedom of movement limited (weekly planning obligatory).

-No access or prepared access to vulnerable groups.

-Enough quantity, little quality.

A positive point is that, although the humanitarian space is very, very limited, there were small improvements in collaboration with the authorities, which is quiet successful knowing the rigidity of the government.

Points of negotiation for the second MoU.

1. Distribution of medicines.

Without any means of evaluation of the impact of the distribution it is impossible to continue a blanket drug distribution. A drug distribution based on monthly consumption and with ‘reliable’ morbidity data can be negotiated. This will certainly lead to a diminution of our distribution activities.

2. Magnitude of the programme, medical approach.

As there is little chance that we can send more expats on the field to guarantee a certain degree of quality we have to limit our geographical area. The option can be to work in a county hospital (paediatric service, bedside consultations???) and the different referral structure up to the grass roots level (home consultation). Where and how can be discussed following the appreciation of the government. The possibilities are

-3 sections are working in 3 county hospitals in one province.

-3 sections are working in one county hospital in their respectively provinces.

In any case one province should be closed after the end of the MoU.

It must be clear that access to the population on all levels and investment in more quality must be priorities.

3. The nutritional program.

During our last inter-desk meeting we all agreed on the fact that conducting a nut. survey was a sine qua non before negotiation of a new nut programme. Actually UNICEF, WFP and ECHO is negotiating a nut survey which includes 2/3 of the overall counties (83 out of 210 are not included) Already now the guarantee to conduct a ‘real’ survey is not very encouraging. This, of course, changes our position. I think: we can no longer insist to do a survey because it is a loosing battle; somebody else will do it. Therefore, I propose to hand over the actual centres to the government or the ones who are conducting the nut survey (because we have no means of evaluation) and keep a nut program incorporated in the above mention medical program. At this time, Sonya is working on an overview and an analysis of the data from the different centres.

4. Institutions.

If there are pockets of malnutrition, they will certainly exist in the institution (social welfare centres, boarding schools, orphanages). Negotiations were already done and limited access was granted [...] but as before the visits, were very often arranged. We should make it clear that we need to have access to the existing institutes, the freedom to make an evaluation and when necessary to set up a program.

Timetable.

Upon my arrival there will be first discussion with the team. On Monday there will be a first discussion with the FDRC on the future. At the end of my visit there will be another discussion on the proposed objectives and a debriefing with the team. Upon my return we should have an inter-desk meeting for debriefing, conclusions and future plans. (13/08/98 if possible). At this moment, it is difficult to put cut-off points. I prefer to wait for the outcome of the negotiations. Voilà, this is a synthesis on what was more or less discussed during our inter-desk meetings. Meanwhile the NK had a reunion on the same issues and it will be interesting to compare both and create a mutual approach (oef). Feel free to give comments appreciations on this. I am leaving on the 29 to NK.

DOCUMENT

Minutes “North Korea Cluster Meeting: Conclusions and Recommendations,” Amsterdam, 29 July 1998” MSF Holland 29 July 1998 (in English).

Extract:

Reading the different documents....

1. Minutes of meeting MSF DPRK in Pyongyang

2. Data on Feeding centres

3. Interpretation of data FCs [...] while taking into account our original objectives […]

1. Investigate whether there is a health/nutritional crisis going on

2. Get access to and assist the population that are victims of this crisis (in case we indeed find that there is one) […] and making the following observations […]

1. We still have not been able to document a nutritional or health crisis

2. We have not been able to gain free access to populations and places and it is unlikely that we will ever get permission to do a random survey.

3. We have not been able to clearly identify who would be vulnerable people other than assuming children in institutions (are there vulnerable families/communities, population groups, geographic regions?)

4. We have been successfully distributing drugs and medical materials of which at least 75% seems to have reached the targeted health structures

5. We do not know whether all populations have access to these health structures

6. The feeding centres we are running see very limited numbers of malnourished children. Not clear whether due to lack of malnourished kids or lack of access. Also effectiveness of treatment of kids in FC cannot be independently assessed. […] We come to the following preliminary conclusions […]

* The programme has so far not been able to achieve its original objectives and cannot be sure that we will be able to achieve them in the near future

* The Korean government still has full grip on us and we might have been successfully used by the government to cover up a crisis

* By lack of other access and due to ample ECHO funding focus of attention seems to have shifted too much towards drug distribution part of programme

Otherwise we feel there are three questions that have so far not sufficiently been answered:

- We say that human rights are violated. Which human rights do we refer to and how are they violated? And what should be our answer to that.

- Who are the vulnerable populations that we should try to access?

- Has there been a famine/crisis and do we know that it is over now?

Balancing reasons to stay...

* We feel that Korean govt is trying to cover up a crisis and denies the population in need to be assisted and given relief. We need to be as close as possible and continue to try and get access, to try and assist (effective humanitarian assistance).

* But even so when can not be very effective, just be present (proximity, solidarity).

* We need to continue to try and witness humanitarian crisis and human rights violations (witnessing/advocacy).

* A change is expected in the short- or medium-term future. A violent change with important humanitarian crisis is one likely scenario. If that happens we should be present and prepared.

* We might not have exhausted all possible strategies yet to gain access.

* One needs to have patience when trying to gain access to a country like N Korea.

* If a new disaster happens we are closer at hand and still have contacts with govt.

[…] Against reasons not to stay:

* Govt seems successful in using us to cover up a crisis and violations of human rights. In this way we implicate ourselves.

* During a next famine or health crisis the same might happen.

* We might never be able to achieve our aims (reach the vulnerable population or to get reliable information).

[…] We conclude and recommend:

We should probably stay and continue to try and build our relationship and build up an information base as well as continue to try and gain access. However, we should, by all means try to avoid being implicated in being used as a cover up by the gvt and therefore there are the following pre-conditions:

-Continue active lobby to gain access to vulnerable populations

-Continue active attempts to gain access to more reliable information and more information sources. Partly this can be done by choosing pilot areas where we concentrate and build up more regular and more in-depth contacts. While at the same time continue a reasonably wide geographical coverage, to be able to travel and note changes in harvest and natural disasters

-Improving basic health care should never become the objective of the programme (can only be used as tool/strategy to achieve main objective).

-Make clear to the outside world that while we do not see evidence of an emergency it does not mean there is none.

Therefore the MoU should include the following:

-As wide a geographical access as possible

-Access to institutions

-Should allow us to intervene during new disasters (floods, as well as droughts, as well as epidemics, etc.)

-Should provide permission to train even at community level

Finally we need to clearly define thresholds that indicate that the moment has come to leave and all sections should stick to that.

DOCUMENT

”Closure, First Episode,” Email from MSF DPRK Coordinator to William Claus and William Bourgeois, MSF Belgian Programme Managers, 10 August 1998 (in English and in French).

Extract:

Hi both,

Attached: the proposition for closing down MSF DPRK. I think it would be good to pass it on to F and H during Thursday’s inter-desk meeting. What do you think? I’ll be absent until Saturday, but I’ll call you on Friday to see what happened in the meeting. Kiss […]

Political matters.

1. Europe level: I presume that the HQ will decide which action and which message to give in Europe. Please, try to do that all the 3 sections together and not 3 different messages.

2. Local level: After some meetings between MSF and FDRC, it appears that the objectives of MSF and FDRC are quite different; the new health policy for the country is to ask for raw materials and rehabilitation of drug factories. MSF is an organisation that works on the field, close to the local doctors and the population. A new MoU will not be signed and MSF will close its mission in DPRK. It will be told at the inter-agencies meeting on Wednesday. As the HQ came to negotiate an extension of the MoU, it is better that the HQ sends an official letter for the authorities for the closure of MSF DPRK.

DOCUMENT

Minutes “International Meeting: MSF Presence in North Korea,” Brussels, 13 August 1998 (in English).

Extract:

Back in April 1998 all sections present in North Korea agreed upon a common strategy as well as the objectives. Those were the subjects of the discussion during the visit of William Claus in July 1998.

DISCUSSION:

After a one-year presence in the country MSF still cannot confirm the alleged severe malnutrition. The access to certain areas or institutions is denied and MSF has no manoeuvre space for any action. Therefore MSF has to react NOW (even in public by a press release) using the data of the 8 months’ study. Is it conceivable to maintain our presence? Presence doesn’t necessarily mean the permanent one but also the regular visits to the country! MSF could stop its activities but continue its presence. Press release? MSF has to go public while having the expatriates on the spot in order to follow up the impact afterwards. Perhaps the press release may push UNICEF, WFP and other agencies to react by having a closer look on the situation and going into institutions. MSF could organise a round table meeting with UNICEF, WFP and funding agencies in order to discuss their approach as well as MSF activities in the country. MSF could combine it with the study of François Jean.

CONCLUSIONS

We agreed upon:

-MSF will close the DPRK mission.

-Press release (end of August or mid-September) saying that MSF is leaving the country and mentioning the reasons why. The data will depend on the confirmation of the rumours about selling of MSF drugs in China.

-Round table meeting in Europe (2nd half of September) with UNICEF, WFP, ECHO, and the NGOs in order to share our information and to discuss the mutual approach in North Korea. MSF Holland is to organise the round table meeting.

-Official letter (within two weeks) to the FDRC mentioning that MSF is leaving the country on the 31st of October 1998 and signed by the president of MSF.

-German money still at the disposal in MSF Holland for North Korea will be used:

° for round table

° to pay the extra costs of the period which is not financed by

°institutional funds especially during the phasing out (to be defined by Marie-Rose and to see with Pim how the remaining money can be used)

-North Korea follow-up is to be done by MSF Holland in order to keep contacts after closing the mission.

-Pipeline: Everything in the pipeline will be sent but no new orders will be introduced.

DOCUMENT

Letter from Ri Si Hong, Acting Director, Department of External Affairs, Flood Damage Rehabilitation Committee DPRK to William Claus, Programme Manager MSF Belgium, 24 August 1997 (in English).

Extract:

Dear Mr. William Claus,

I would like to express my thanks to you and MSF for providing sincere assistance to our people who are suffering from shortage in medicines due to natural disasters lasting for several consecutive years. Your humanitarian assistance encourages our people to get rid early of the aftermath of natural disasters and has been used effectively in curing patients. I also take this opportunity to highly appreciate Madam Marie Rose Pecchio and MSF team members for their work in our country and express thanks to them. We will not forget MSF for its assistance to us suffering difficulties.

Mr William Claus

Médecins Sans Frontières

Brussels, Belgium

We hope you and MSF pay deep attention to provide pharmaceutical raw materials as we have proposed during your recent visit to our country. I wish you and MSF every success in future work.

INTERVIEW

The lack of access, the inability to evaluate the quality of our programme and the lack of any perspectives of improvement all led to our decision to withdraw. I understand Marie-Rose’s reasoning. But we were talking about a budget of 5 million ECUs; we didn’t want to invest on this scale anymore. They wanted us to continue with the distribution like before and nothing on their side guaranteed that we would have increased access to orphanages or psychiatric institutions. We had no access where we really wanted to work. Our ideas didn’t interest them. They didn’t want us to be present with expatriates outside the capital. They said that they were capable of doing the work themselves, that they were just short of material. When we talked to them about medical issues, you’d think all diseases had been eradicated in Korea, listening to them. So in the end, when I negotiated for a possible new contract, I said to them: ‘We want free access, we want to carry out a nutritional survey.’ They replied: ‘We understand.’ But they didn’t need MSF anymore then. They knew there were plenty of people involved on the ground who would do as they were told, plenty of money available, plenty of NGOs around, so they could do without us. As for staying to distribute medicines and material they just needed to call DHL – they would have come to do the same thing!

William Claus, MSF Belgium Programme Manager, (in French).

INTERVIEW

We had to renew a sort of collaboration protocol with the authorities. For this, the authorities summonsed us to Pyongyang to tell us they were very happy with MSF’s work. They were delighted with our collaboration and had decided to continue with MSF. They also told us that from now on, it wasn’t worth MSF teams leaving the capital because we’d done such a good job of training the North Korean teams. So in the future, MSF would just intervene at capital level. They announced all this in Korean-fashion; with a big smile. Yet during my visit I couldn’t have explained our conditions of intervention more clearly to the person in charge of humanitarian aid, telling him it was all or nothing, and if these conditions weren’t respected MSF would prefer to leave. When he made this proposition to the local team, I immediately wrote him a letter saying: ‘When I consider what was said in our previous meeting, which you no doubt recall, I can only think there has been a misunderstanding. I explained to you at the time that MSF would never accept to work at a distance.’ Obviously I never received a reply to this letter. He didn’t even tell the local team he’d received it. It was a polite expulsion; in Korean-fashion. We didn’t leave; they kicked us out. We fought to the end for access to the victims. Obviously this begs the question on where the limits to this fight should be.

Dr. Eric Goemaere, Executive Director MSF Belgium, (in French).

INTERVIEW

It was framed as a MSF decision not to continue but the North Koreans set such conditions that it was in fact, their decision that MSF could not continue. I think on that point, there was not much disagreement anymore between the sections. In the end, we did not have a lot of disagreement that we had to withdraw - the North Koreans were making it impossible for us to work. The least we should do is have a conference and share our information with everybody else who is relevant. I think that we should have stayed there because we should have realised when going into North Korea that this is such a country and you measure success by the millimetre and the progress you make per year - or five years. You should not have approached this like the Great Lakes. Or, as any other situation. You should have realised before that this was going to happen and if you want to work there, you have to accept that this is the way.

Pim De Graaf, MSF Holland Executive Director (in English).

INTERVIEW

It was clear that the government didn’t kick us out but told us very friendly: ‘It’s the end of the project, now you must go.’ It’s a country that needs assistance, they’re trying to get everything they can get, just to keep things going. From 1995 on, more and more NGOs were willing to go there and in the end, they had such a choice of NGOs that they could easily trade one in for another. They must have had so many visits from NGOs and they knew exactly, at the EU level, how much money was on the shelf for North Korea and that they could only get it from an NGO. They were only trying to get that money. Its just politics from North Korea. I don’t think there was a special relationship between MSF and North Korea.

[...], Physician, MSF Programme in DPRK, September to December 1995, January 1997, June 1997 (in English).

INTERVIEW

We had this meeting with the whole team and the other meeting with William [Claus, MSF Belgium Programme Manager]. We said that we wanted to work in our own province. And that’s what, on August 7th or something, William and Marie-Rose proposed to the FDRC. They answered: ‘no. what we want is that you give us more raw materials and that you help rebuild our system.’ So that’s how the things ended quite naturally. All the expatriates were here for 6 or 12 months and everybody was a bit exhausted. We’ve already tried and tried to find the children, and it was difficult. We wanted to do a nutritional survey and they didn’t want us to do it. The team was demotivated. As for the management team, I can imagine they were triple demotivated after the press releases. After one or two weeks, William came back to see the authorities and said something like: ‘this is what we want, this is what they want, it’s not the same, so we leave. Because we don’t get access, it costs a lot; we have no guarantee that it’s going to improve. This is it.’

Dr. Corien Swann, physician, MSF Programme in DPRK, January to September 1998 (in English).

On 19 August 1998, with some journalists having heard about MSF pulling out of North Korea, MSF started to develop a communication strategy. The same day, on its return from a 4-day visit to Pyongyang, a US Congressional delegation stated to CNN that since 1995, 10% of the North Korean people might have died from hunger.

DOCUMENT

“MSF’s Pulling out of North Korea,” Email from Peter Thesin, MSF Belgium Press Officer to MSF directors of communication and press officers, 19 August 1998 (in English).

Extract:

Dear all

The fact that MSF will pull out of North Korea has reached the ears of journalists. During a meeting among the 3 different sections last week it was decided that:

-An official press release will be written to explain the reasons why MSF will withdraw from North Korea. The timing of that will depend on the outcome of survey among NK refugees done by Paris.

Before that there will no official statement of MSF.

-After the press release MSF will organise a round table conference to discuss the NK challenge with UN agencies and NGO’s. If everything goes well, this should take place at the end September, beginning of October. You will be informed about it. If journalists are calling about an eventual withdraw of MSF you can tell them that, the results of the last negotiations on a second Memorandum of Understanding were negative. The authorities asked MSF to intervene in the rehabilitation of the existing pharmaceutical industries and the delivery of raw materials for the production of medicines. MSF insists on having access to the population, reduction of the actual program, access to vulnerable groups and provide more quality inside the program. It is obvious that both points of view cannot be matched.

-There will be an official statement from MSF as soon as we have all the elements to make a good and unique press release.

-We still have teams on the ground that are continuing the work.

We will keep everybody informed on all the developments.

DOCUMENT

“North Korea,” Email from Justine Geldard, MSF Hong Kong Press Officer to MSF communication directors and press officers, 20 August 1998 (in English).

Extract:

Below, please find one of the many articles in today’s press quoting MSF’s William Claus on North Korea. AP called me yesterday asking for details of MSF’s withdrawal from North Korea. As this was news to me I called William Claus. The line I got from William is:

1)MSF is negociating access to target populations, institutions, vulnerable groups…

2)The govt. priorities do not seem to be the same as MSF’s

3) Should we not be able to reach an agreement we will have to review our position

“Famine may have killed 2 million in North Korea” – CNN – Beijing – 19 August 1998.

Two million North Koreans - nearly 10 percent of the population - may have died during three years of famine in North Korea, U.S. congressional aides said Wednesday. [...] “The food shortage continues,” said Mark Kirk, one of the bipartisan delegation’s four members. “They are out of food. That’s clear.” Over the past three years, the famine has killed an estimated 300,000 to 800,000 people annually, with the number of deaths peaking in 1997, Kirk said. He said the figures came from U.S. government sources, refugees and North Korean exiles. “Two million would be the highest possible estimate,” Kirk said. Deaths were most likely from famine-related illnesses, like pneumonia, tuberculosis, and diarrhoea, rather than starvation itself, he said. [...]

Meanwhile, an official from Doctors without Borders said on Wednesday that the medical aid group may leave North Korea unless the government grants it better access to people sickened by famine. Doctors without Borders has distributed medicines in North Korea for a year, but has found it hard to gauge the results because of the government’s lack of cooperation, said William Claus, an agency official based in Brussels. The group, one of a half-dozen aid organizations in North Korea, has 12 people working in the three provinces, Claus said.

From 18 to 25 August 1998, the MSF France team in China together with François Jean, from the MSF France Foundation, carried out a second assessment on the border between China and North Korea. Beyond collecting testimonies, their aim was also to explore options for the delivery of assistance from the border both to the refugees and to the people inside North Korea through cross border activities. On 9 September, extracts of the testimonies were published in the South China Morning Post, presented as collected by an MSF team.

DOCUMENT

Minutes of MSF France’s Board of Directors’ Meeting, 28 August 1998 (in French).

Extract:

North Korea

The negotiations for an agreement protocol with the North Korean authorities did not reach a conclusion. Our activities are suspended as from the end of September. François Jean is carrying out an exploratory mission on the Sino-Korean border to collect witness accounts from North Korean refugees and academics, identify a network, and look into future work possibilities. They will be discussed upon his return in early September. MSF would like to organise a round table in mid-October with external participants who have a wider analysis of the situation and the system.

DOCUMENT

”Exploratory Mission to the Sino-Korean border – 18 to 25 August - Marcel Roux, Marine Buissonnière, Dou Rae, François Jean,” Report, September 1998 (in French).

Extract:

This mission had a double objective: collect refugee testimonies of the situation in North Korea and look into possibilities for future work in/around the border area. We will not go into the first point here other than emphasising that the testimonies collected, conform to those of last April’s mission, and above all are coherent with researchers’ work on North Korea. The refugees’ personal accounts confirm, detail, and shed light on the analyses of academic specialists on the North Korean economy and system. Above all, we aim to share our reflections on the operational side of things. Obviously we are not in a position, at this stage, to make any detailed propositions. This brief visit to the border was just the first stage in the search for a new way of working in Korea, or at least that is how we see it, and as a first step: we have decided to try something from the Chinese side. Marcel, Marine, and Dou Rae are keen to be involved in the attempt to find new modes of intervention, because this is what is required and there is obviously a volunteer aspect to such a plan. First of all, because we do not want to drop the North Koreans, given the terrible situation they are in at the moment, and then because we are well aware of the difficulties with and limits to the aid we would like to provide via China to those left by the wayside in North Korea.

What does this involve?

1) Help to refugees

Little working space in China (!), especially for a foreign organisation […] leaves a very limited possibility, given the few working options of supporting individual initiatives or the action taken by certain networks, whilst first ensuring that the support we offer is not superfluous (aid from Korean or American churches, the same networks)? In short, it appears that there are limited possibilities, especially bearing in mind the outcome of those caught by the business of fines for providing illegal aid […] At first glance, however, it seems that there may be more possibilities in Yanji (town/anonymous, Korean/Chinese, prefecture/autonomous, investments/business, etc.), maybe also at Hoonchoon, and therefore possibly to access Russia (?), and in places where the China/Korea dilution is more balanced: to be explored […]

2) Aid in North Korea

We think that it is possible to provide aid to the population of North Korea from China. This is not the easiest option, obviously. China, as you can imagine, would take a dim view of humanitarian initiatives starting up on one of its most sensitive borders. And as for North Korea, it is not very open to cross-border activities, to say the least! Yet we think it might be possible to start something up, on the condition of being discrete and indirect, i.e. leaning on the Korean-Chinese networks. We may even find that this unfavourable environment produces less constraints than the one we have been struggling with inside the country for the last year, where it seems unthinkable, if not impossible, to break loose of the framework fixed by the regime for international aid. At least here we are outside the framework and perhaps it will prove possible to cross the border without being sucked into the regime’s distribution system? We have to try it out. It is obviously possible for Koreans who try and help their families. A lot depends on our capacity to connect up with Korean networks that can help us identify groups of beneficiaries, take up contacts with local authorities concerned about the outcome of people previously under their direction (directors of factories or institutions, etc.) and reassure ourselves that our aid really manages to reach, at least in part, those who need it. As you will have noticed, all this is still very theoretical. It raises a lot of questions - particularly on the possibilities of dealing with things on a local level – and we will only find answers by trying, following a progressive and cautious approach. Whatever the case, we are well aware of the difficulties and limits of this project. Without counting the paradoxes and dilemmas raised by the question of aid to North Korea in general and this approach in particular. So, a border intervention;

- Would involve a cautious, discrete and indirect approach for work which will at best remain very limited with regard to the scale of the needs […]

- Would also require patience and perseverance with commitment over the long term, which is obviously out of step with the urgency of the situation […] but it is the only way to maybe, gradually, end up producing concrete and direct aid.

Theoretically, there are two types of possibilities: supporting the organisations or networks already involved in supplying aid across the border or building up our own channels.

-The first option strikes us as the most promising. Following our initial discussions with people already involved, it seems that the problem is not so much the lack of means but the difficulty in building up channels and setting up operations over and above small networks and acts of family solidarity. Once they go over a certain volume, those Koreans in China looking to help their close circles find a commercial cover for the food they send through. As for the rare organisations involved (Korean Buddhist Sharing Movement, for example), they have only managed to get very modest amounts through (271 tonnes in one year), split up between small dispatches (on average 10 tonnes per operation). We have been told that a modest approach is the best way to guarantee an effective and equitable distribution at local level, as all bigger scale operations risk getting recycled into the impenetrable circuits of the regime’s distribution system., which is why the problem is less about reinforcing existing initiatives than multiplying the channels; which doesn’t exclude looking to set up forms of collaboration with the organisations involved – on the contrary?

-Setting up our own channels implies building up a network, perhaps creating an ad hoc organisation and above all finding the right people […] We’re aware that all this sounds both trivial and a bit megalomaniac, but we’re not in a position right now to be more concrete. Propositions will follow and become more detailed during the exploratory process we would like to carry out.

To stick to the main points, it seems essential to us, at this stage, to multiply contacts in the northeast, and particularly in Yanbian. First of all with the Koreans in China (religious network, others active on this issue and businessmen), then with the Chinese in contact with North Korea (on this point, having no ‘guanxi’ in the region is definitely a handicap whilst it remains a fact that senior staff here could undoubtedly facilitate our contacts with certain local authorities on the other side of the border). Finally, it would no doubt be interesting to look at the ‘development area’ of Rajin-Sonbong (to see if this region could be an access point into North Korea or if it’s just an investment area set apart from the rest of the country). These contacts aim to form a better definition of the existing networks and a better understanding of the ways people involved in aid and cross-border commerce go about their work.

If we open up operational possibilities on this border, we will eventually - and may be even rapidly, if a visit takes place to Rajon-Sonbong - have to address the question of institutional positioning. It maybe better, both with regards to the Chinese authorities of the Juche regime and for our involvement in North Korea and the accompanying public debate, that MSF does not act in its own name. Which begs the question of creating a cover association or a business screen? The latter is perhaps the best solution whilst business, paradoxically, remains the best way to way to approach this Stalinist regime, as demonstrated by the fact that most cross-border initiatives adopt a commercial cover – but we could also think of an UDA-type solution. Whatever the choice, we need to keep it as simple as possible: we could trip ourselves up if things get overly sophisticated […] This is not about hiding the links with MSF but maintaining a certain distance in order to open up working space whilst preserving the possibility of taking critical and public positions with regards to North Korea.

In Korea like anywhere else, our working possibilities will be largely dependent on the people starting up this mission. In Korea, more than elsewhere, everything depends on the people: determination to do something in a particularly difficult context, innovation in the ways of working, building up a network and managing from a distance. […] Once again, we’re looking for rare birds – but we’ve already got a few! Marcel, Marine and Dou Rae are ready to invest in this effort, which is already looking like a long haul. This team has a lot of advantages: motivation, quality of contacts, knowledge of China, aptitude to weigh up the possibilities in a context full of constraints, etc. and for Dou Rae, knowledge of certain Korean networks.

So the exploratory phase can start already […], as soon as the team of this already overloaded Chinese mission has organised itself for taking on the new priority at the Korean border. As a first step, the team needs to find the time for two or three trips to the northeast to connect up with the networks involved and listen to their experiences so we can hone our own approach and define the ins and outs of our intervention. We should also use this first stage to identify any networks/organisations for future collaboration and recruit staff from the Korean community in China (or Australia, Canada, Japan etc.). This recruitment will be critical for the operation’s initial phase given the central role the person/people chosen will play in piloting a programme that, for practical reasons such as exercising discretion, MSF expatriates cannot be directly involved in. Here again, we need to find the right person/people. It’s not possible to fix a time scale for all this, but ideally we should pass from the exploratory phase to the operational phase next December.

Young men: 19 and 25.

Crossed the border July 29, 1998. Interview conducted in Yanji, Yanbian Autonomous District, August 22, 1998

There are six of us in our family, my father and mother, my older sister, my two younger brothers and me. We grew up in Musan, a town close to the Chinese border. In 1989 my father, who was 45 years old, died of a bowel infection. My mother remarried in 1992 and we went to live on the east side of the country in Chongqing. We lived reasonably well during 1992 and 1993. However, at the end of 1993, the distribution of corn became more and more infrequent. Up until this time, the highly organised system for issuing rations was clearly defined:

-Adult - 700 grams

-College graduate - 600 grams

-4th year senior school - 500 grams

-Junior school - 400 grams

-Infants - 100 grams

-Honoured senior citizens - 600 grams + 2 won per day

Nowadays these same criteria are used on national holidays for distributing rations. In 1995, rations were distributed every 3 to 4 months. Then, they were distributed on national holidays, which are the 1st January, 16th February, 15th April, 9th September, and the 16th November. On each national holiday, we would receive the equivalent of two days worth of corn, which is 1.2 kilograms per family. Our 22-year-old brother died of hunger in 1997, proof that the distributions were not enough to live on. My older sister is married and lives in the country where she works on a collective farm at Kyangsan in Hangyan Bukdo. Occasionally, she would give us some maize or farm produce, which we could resell on the markets. We could then buy corn flour or larger quantities of cheaper corn with the money we made. She is able to help us because she is allowed to farm a small plot of land in the mountains and keep the produce for her own consumption. Evidently, the same thing is not possible in town and town life is much tougher than life in the country.

Another way of making a living was to go to the coast and collect shellfish and seafood to sell in the markets. North Korea has markets instead of shops where everyone trades and is able to buy corn, food, and medicines. These markets are only allowed to trade in North Korean foods. It is forbidden to trade in foreign produce, which is what everyone is looking for because Korean produce is of a very poor quality. Those who trade in clothes from China remove the labels to avoid being caught. The only way to obtain medicines is to buy them from the markets because there are none in the hospitals. Doctors also recommend that herbs and roots be gathered from the mountains.

The government gave us very little explanation in 1993 when the reduction in ration distributions began. We would see the international aid come in to the port of Chongqing. It would be stored in the distribution centres then divided in order of priority between the army and executives. More than 70% of the aid would be allotted to them with the remainder being distributed to the people on national holidays. Some of the executives together with members of their families would take advantage of their position and their contacts to make a very profitable living by reselling the corn in order to amass other goods; consequently, a small portion of the aid would end up in the markets. Bearing in mind that a kilo of rice sells for 70 wons and a kilo of maize for 35 to 45 wons, most people buy corn flour or its by-products whereas executives buy goods of a higher quality.

I graduated after two years at a college specialising in car mechanics run by the army. After graduating, I was assigned to work in a factory but I am only a name on a list of employees as I did not go to work because we were not paid either in money or in corn. My brother and I spent most of our time doing a little trading in order to buy food but life in North Korea was becoming more and more difficult and we could no longer make ends meet. We have family living in South Korea and America but it is not possible to contact these countries from North Korea. Consequently, my brother and I have come to China to contact these members of our family and ask for their help. Travel nowadays is possible providing you are discreet and do not shout about where you are going nor where you come from because the tight restrictions on travelling which used to make it very difficult to move about are not so rigidly enforced. However, there is a 50-won fine for unauthorized travelling if you are caught.

We left Chongqing by train on the morning of the 29th of July and we arrived in Musan after travelling for 3.5 hours. We then walked for 2 to 3 hours until we came to the border. Everyone in Haeliang knows that the way of life is better in China and lots of people would like to cross over the border but we cannot say this sort of thing openly. You are committing a crime by saying: ‘it’s better in China,’ and everyone is busy watching everyone else.

You do not see bodies piled up by the side of the road because there is a regular collection service. However, there are often accidents on the overcrowded trains. I have seen people travelling on the roof get electrocuted and others hanging on to the doors who fall from the train. You see lots of very thin children who have to steal to eat wandering about. Many of the young would like to join the army in the hope of receiving rations however poor they may be. They do say that particularly weak soldiers are sent home to get their strength back. In any case, I could never join the army. I am automatically disqualified because I have family in America and South Korea. This does not affect my daily way of life but I could never improve my social standing. […] There were elections this last 26th of July, which gave the government the chance to change the residence permits known as ‘Huxi’. This does not change a great deal for us and so is not really very important.

DOCUMENT

“Tales of Hardship,” by Jasper Becker, Beijing, South China Morning Post (Hong Kong), 9 September 1998 (in English).

Extract:

The following are extracts from interviews with North Koreans by Médecins Sans Frontières on the Chinese frontier that give insights into life in the stricken country.

Counting children and grandchildren, we were a family of 14. Seven are dead in North Korea, the rest of us have been hiding here for over a year. We crossed by giving a guard a bicycle. We last had rations in 1993. The government said in the interior of the country every district had to solve its own food problems. At the time, people wrote to the government expressing dissatisfaction: they ended up in the camps. I am a retired soldier. Many years ago I fell sick and so had to leave the army. My son was an army cadet. Soldiers received daily rations although it was not enough. So the chief of my son’s unit ordered them to forage in the countryside. Small companies were sent out to steal village stocks and if they found nothing in the granaries, they robbed people’s homes. One day my son protested and said he was not in the army to steal from people. He was immediately shot. Today people are afraid of the army. They dare not even raise animals for fear they will be stolen. After the death of my son I went to his superior officer and asked for an explanation. We were beaten and I was put in a labour camp for three years.

Soldier, 35, and his 9-year old son:

After I left the army in 1994, after more than 10 years’ service, I found out that outside people had nothing to eat. In 1995, an ordinary soldier had 200 grams of food per meal and three meals a day. The best rations were for pilots who obtained 800 grams a day. Today, I hear only people in Pyongyang still eat well. People who work for the secret police, the security services and the cadres get food distributed every three or five months. When a shipment arrives, 30 tonnes of cereals for example, 20 tonnes are first distributed to the army, then the cadres take what they need. What remains is distributed to the population during festivals.

Two brothers, aged 15 and 19:

We were a family of five from Haeliang. Father worked in a metal factory. Four years ago, he died of para typhus. Our mother died of typhus in the same year. Soon afterwards, our younger brother, who was five, died of an inflammation of the intestine. We lived with our grandfather. At first neighbours helped us with a soup or rice or maize, so we could survive. Then people had nothing to give us. There were corpses in the road. We had to leave home and travel around to find food. Four months ago, I joined some friends and we crossed the frontier. Through begging I managed to earn 300 Yuan (about HK$280) and went home. Grandfather had sold the house for 300 won (about HK$15). We took to the road, together this time with two other boys. Because we had money we could take a train. The railway cars were locked and those who died were simply piled up by the door. When we got to the frontier we just crossed the river. It was easy. When we have enough money we will go back.

Couple with infant from Hyesan, a town on the border with China:

If one is denounced for saying traitorous things, punishment is dealt to the whole family down to the third generation. So one keeps everything inside. Everyone is frightened. The situation today is terrible. Many people have walked to Hyesan. Many children are without strength. Their heads are swollen and eyes barely visible. Their limbs are bloated; the skin is black and infected. The government tells us we have to tighten our belts until 2003. North Korea is too proud to accept foreign help. They even tell us that the clothes from China carry viruses, that the food aid makes one lose weight and that the foreign medicines make one sick.

INTERVIEW

Before I joined MSF I spent time in South Korea, doing a Masters in political science on North Korea. I was working in the Paris headquarters when MSF responded to North Korea’s call for international aid in 1995. I’d followed MSF’s involvement in North Korea in detail with Marc Gastellu, who was deputy operations director at the time and in charge of this dossier. When MSF won the Seoul Peace Prize in 1997, Philippe Biberson asked me to give him some South Korean contacts because he had to go over there and he wanted to learn about the norms and customs, the positions to assume during his visit. So I was involved in these two ways. Then a third occasion came up when MSF was preparing itself to pull out of North Korea in the summer of 1998. There was no doubt that operations were coming to an end and the Memorandum of Understanding would not be renewed. At the time, MSF France wanted to document this famine to show how it was being manipulated, and explore operational alternatives. This was when François Jean, who worked at the Foundation, asked for my help in setting up contacts with people in my network, and proposed that I accompany him to South Korea. We left in August 1998, and we met people working on North Korea, mainly South Korean academics who are very involved in this research topic, which has a direct impact on them. I’d maintained contacts with them and others, mainly protestant organisations who provided one-off aid to North Koreans in an unofficial and clandestine manner. We did some exploring on who did what. But François’ objective was to research the situation to show that aid wasn’t reaching the most vulnerable people and then go on to improve the information available on the mechanisms of power and the system in place in order to demonstrate that humanitarian aid could never reach the most vulnerable people. The system was discriminative by nature, so once aid passed through the system, it followed the same lines.

Sophie Delaunay, research officer, Foundation MSF France, June to August 1998 (in French).

INTERVIEW

The second trip took place during the summer with the first stage involving François [Jean] and Sophie [Delaunay] in South Korea. They contacted activists heading groups working with refugees on the border and researchers working on North Korea. These latter could help us understand how North Korea’s society and economy was structured. Then François continued on with us - Marcel, the Korean who worked with us at the time and me - the 3 people involved in the first exploration. We went up to the border and saw not just all the people we’d met in March but also the contacts arranged beforehand by François and Sophie during their visit to South Korea. This allowed us to complete our image of what was happening on the border. We did the same exercise: meetings with field activitists involved in the provision of aid and direct meetings with North Korean refugees at different points on the border, via different networks. This gave rise to a second report, which tried, with François’ support, to be less anecdotal and more structured with regards to the elements we were trying to understand through these people’s stories. We can’t claim that our methodology was perfect but we wanted to go further than the March report.

We received confirmation of our suspicions about the system, its class structure, the discrimination existing since 1953, which had always been behind the organisation or structuring of the country, and thus access to services and daily needs, and which simply continued when international aid appeared. This aid was channelled via the public distribution system, which discriminates against its population, and so aid became a tool for discrimination. We also learnt a bit more about how the army was organised. Because North Korea has been technically at war since 1953, but also because the army has control over the country and so forms part of the privileged groups receiving assistance. We learnt more about how this assistance worked: The stocks were used to feed the army, with food being stored for war efforts, the party’s senior officials, and those loyal to the regime concentrated around Pyongyang and the big towns, on the main routes to the capital, with this class of the faithful representing around 11-12% of the population and controlling the country.

We built up a vision of the destruction and violence generated by this system when we met people coming from the camps. We obtained confirmation of economic events since the collapse of the Eastern bloc and a famine which started at the beginning of the ‘90s, affecting the hostile classes first of all and reaching the upper classes in the middle of the ‘90s (‘94-’95), i.e. at the moment of the call for international aid and MSF’s arrival. We made the links between what had happened during North Korea’s economic collapse, the way the system was structured and the way assistance had been channelled. It echoed what had transpired during our time inside the country and the difficulties we had in our work, which had pushed us to question the pertinence of being there at all. We realised that this assistance was used to reinforce a regime that oppressed its own population and didn’t reach the most vulnerable people it was meant for.

Marine Buissonnière, administrator, MSF France in China, December 1996 to January 1999 (in French).

On 9 September 1998, the MSF USA Programme Officer and a group of US NGOs held a meeting, with US Congress representatives and the UNICEF representative in North Korea.

INTERVIEW

Our message was in total contradiction with what other American NGOs and Congress were trying to say. During this meeting, I was shot down in flames The American NGO community, like Congress, was interested in Korea. Korea always aroused strong feelings in the United States. It’s a bit like the Congo for the Belgians. There have always been links and religious American missions installed over there. There was the Korean War. There was a meeting on the morning of 9th September, and the doctor Omawale of UNICEF, the European Union representative for Asia and the N° 2 for the WFP were all present. There was certainly someone from USAID or the government or State Department as well and American NGOs working in the WFP consortium.

In September 1998, all American NGOs intervening in North Korea were under the umbrella of the WFP. They weren’t authorised to send American personnel, so they weren’t directly operational and were fighting for one thing only – which they got a year later – which was independent recognition i.e. to be able to register themselves directly with the North Korean government. Their objective was carry out direct operations in order to show the American-Korean community that they’d got further than the American government, etc… For them, MSF was registered with the North Korean government, had personnel in the field and – despite all the well-known constraints – had what they considered to be a certain access to the population, so when they heard us saying: ‘we’re leaving, we don’t want to work there any more’ it caused a riot, they were completely beside themselves. They said: you’re totally mad.’

Dr O. of UNICEF said to us: ‘MSF, you’re arrogant. You haven’t understood the Korean culture. It’s a culture of long negotiations. UNICEF has gradually managed to open up regional offices in different provinces where we didn’t have access before. You haven’t understood, it’s a long term problem etc.’ The American NGOs remarked in front of the European Union representative: ‘well well, how strange, you’ve taken this decision to pull out just at the time your European Union funding has ended.’ They tried to sink us with this issue. Of the three provinces we were working in, the programme run by MSF Belgium and part of the one run by MSF Holland were almost 100% financed by the European Union. We couldn’t deny that we were heavily funded by the European Union. The American NGOs were really happy to expose MSF’s dependence on a donor: ‘and not any old donor! The European Union, no less!’ It was painful because MSF Belgium hadn’t been very clear in its relations with its donors. As for the European Union representative, he was lapping it up. He said: ‘its true MSF approached us. Yes, we’re funding their project etc.’ Deborah Yang was there for Tony Hall, the Congressional representative pushing for increases in aid to North Korea. She became completely overwrought, saying: ‘MSF, you can’t do that. You can’t leave Korea. You can’t say these sorts of things right at the time we’re approaching Congress to ask for more aid. It sends a completely contradictory message. You must review your position!’

That afternoon, with the same working group, we had a meeting with the three representatives of the Flood Damage and Rehabilitation Committee of the North Korean Government. One of the three started out by announcing: ‘we’re having difficulties with one organisation, which in English must be called: Doctors Without Frontiers.’ I was in the room, I said: ‘yes, you’re having difficulties with us.’ The guy wasn’t expecting someone from MSF to be there, annoying him again in person. So I spiced things up a bit, saying to him: ‘I can explain why we’re having problems, etc…’ That’s how we started a bit of participation in this working group of American NGOs. We tried to work out what they were doing. We weren’t able to change much.

Antoine Gérard, Head of Programmes, MSF USA, (in French).

On 21 September 1998, UNICEF, WFP and the EU received authorisation to implement a nutritional survey in North Korea. The team was able to access a third of the country’s territory where international assistance had previously been present, however this team was blocked from visiting another two-thirds of the country that remained cut-off from foreign visitors.

DOCUMENT

”The Difficulty of Carrying Out Surveys,” Romain Franklin, Libération (France) 30th September 1998 (in French).

Extract:

The difficulty of carrying out surveys:

On the 23rd September, North Korea gave permission for the first time for a ‘nutritional survey’ to be carried by the World Food Programme (WFP), UNICEF and the European Union. But the survey can only take place in 130 counties out of 210 in the country [...] excluding the areas on the border with China where most of the witness accounts collected by MSF come from. WFP, which works in 12 North Korean provinces, states that it has only come across diversion of aid once, in February: “1000 litres of oil provided by the WFP were found in three shops in Pyongyang,” relates Christiane Berthiaume of the WFP. UNICEF states that it is equally unable to draw up an overview of the famine, as does the International Federation of the Red Cross and Red Crescent, which has had seven people on the ground since 1995. “We’ve never seen people die of hunger. The only thing we’ve been able to see are cases of chronic malnutrition,” reports Michel Tailhades, a doctor from the Federation; his organisation “can control” the destination of its aid and “no diversion has been observed”. But nonetheless the Federation has a very wide mandate. The objectives of the different organisations on the ground vary, and “if we want to have a long term impact, we have to stay in the country.” Action Contre La Faim (ACF), present since early 1998, is not ready to venture an overview either. Jean-Fabrice Pietri, Coordinator, nonetheless talks about the difficulties encountered for “really reaching the most vulnerable. We suspect that there are areas of the country where the situation is more serious”.

On 20 September 1998, the MSF North Korean Programme Managers worked out the message to be issued to the press regarding MSF withdrawal from North Korea. An embargo was put until 30 September, the date of the planned press conference. On 28 September, the executive directors of the 3 sections present in North Korea informed the FDRC that MSF would issue a press release to explain its departure from North Korea.

DOCUMENT

“North Korea Press Conference,” Email from Pierre Salignon, MSF France programme manager, 24 September 1998 (in French).

Extract:

Hello everybody;

Last Monday, a meeting was organised to speak about the next press conference in HK about North Korea. Please find enclosed a little update about this meeting. The press conference will be organised in Hong Kong the 30 Sept 15h00 (9h00 Paris time). Possible attendees: Eric Goemeare, Dominique (?) doctor MSF Pyongyang, Marine MSF Beijing who went to the Chinese border and may be Marie Rosé HoM Pyongyang. Samantha will be in charge of the organisation of the press conference.

Content of our message (sorry in French I already wrote it before):

1/ MSF is obliged to leave North Korea (not a voluntary departure; health is not a priority for the authorities; request for basic materials by the authorities to re-launch their pharmaceutical industry, impossible to have access to/proximity with what we define as “vulnerable groups” – nothing like the more political definition of the authorities - etc.).

2/ Obliged to leave whilst being convinced that the situation will get worse and thousands of people will continue to die and pay the price of the regime’s policy. Evidence of a catastrophic food situation, no matter what it’s called (famine, food shortage etc.) ref François Jean’s arguments. There were discussions between the sections to see if the term famine was appropriate. Opinions are divided. This is not like a Sudanese famine, but the consequences of 1) a structural food deficit lasting several years; 2) a distribution of the available resources by the regime in accordance with what it considers the priority for its survival (meaning that certain categories of the population are absolutely not priority). People are dying because they are weak, victims of a chronic food shortage to which the implosion of the health system should be added.

3/ Illustrations:

- Analysis of MSF’s medical programme during the last months of its presence with all the limits of our position; implosion of the health system, future very black in terms of health, etc.

- Evaluation of the situation of children in institutions (ref Dominique’s report which ties in with info obtained on the Chinese border; lay out currently under revision).

- Witness accounts from refugees on the Chinese border (ref report in the process of being translated into English).

4/ Analysis:

- Terrible situation, perversion of the system, inadequateness of the aid system (assistance doesn’t reach the most vulnerable, no control possible etc.) etc.

- Urgent that the community of international donors redefines it’s policy and conditions for the delivery of aid, and stops looking the other way when confronted with such a system.

Documents to be circulated: testimonies collected on the border (we’ll get the translation done in Paris), press release announcing MSF’s departure and the reasons why, Dominique’s report (summary) on the children in institutions. Embargo with the media until 30th September, contacts on national level in France, Belgium, and Holland + other sections in process/to do. Concerning Paris, contacts have already been taken up with the different press including the daily papers (Libération, Le Monde, etc), the weeklies, and the radio. It seems that the announcement of our departure has raised a lot of interest due to the analysis we have built up these last few months, the border visit, the work on children in institutions, our analysis of the health situation and our conviction that thousands of Koreans will continue to die. So we can expect a lot of coverage in papers such as the Libération, which wants to publish special dossiers on the 30th or 31st September to accompany our departure, including interviews and using the documents that will be distributed during the press conference. None of which will please the North Koreans.

Marie-Rose and Sonja in Pyongyang and Brussels have been informed due to the planned departure of the last MSF staff from the country on around the 5th October. That’s it, in short.

Take care

PS English translation of witness accounts collected from the refugees on the border is in progress. It will be available by Monday morning at the latest and passed on to Samantha and the MSF network.

DOCUMENT

Minutes of MSF France’s Board of Director’s Meeting, 25 September 1998 (in French).

Extract:

A press conference will take place in Hong Kong on the 1st October to announce and to explain our departure from North Korea . Philippe Biberson emphasized that we must nuance our discussions because our position is complex to defend. We should not say too much and at the same time, we must be able to give factual arguments, otherwise people will suspect we are too ideology-based. On the 21st of October, there will be a meeting along these lines in Amsterdam. From now to the end of the year, 5/6 people will meet to reflect on a more political discourse: how does the system function? How is it organised? We should put together all the refugee testimonies over the last few years.

We should put together all the refugee accounts collected over several years.

DOCUMENT

Letter from Lex Winkler, Executive Director MSF Holland, Alex Parisel General Director MSF Belgium and Karim Laouabdia, Executive Director MSF France, to Mr Lee, FDRC, 28 September 1997 (in English).

Extract:

Dear Mr Lee,

Since the FRDC and Médecins Sans Frontières could not agree on the terms for renewal of the Memorandum of Understanding, we currently are in the process of finishing our activities and closing down our offices in Pyongyang. Since the start of our activities in DPRK, in June 1997, we have repeatedly expressed our wish towards FDRC to have more direct contact with the population while giving humanitarian assistance. The assessment of the extent of the needs in the field of nutrition and medicine and the monitoring of the results of our work are common standard in the field of humanitarian work. They also are part of the accountability required from us by our private and institutional donors. The restricted access granted to us in DPRK limited our ability to assess correctly the needs in the provinces, to monitor the use of the drugs supplied by us and to collect relevant medical and nutritional data that would support our work. For that reason we have consistently expressed our disagreement with the working conditions imposed on us. However, we have seen sufficient malnourished children to be convinced of the need for more attention and better assistance for these and other children. Also, we have seen many needs in the medical field that should be urgently addressed. To these observations were added accounts from North Korean refugees in China; they witness about the extreme medical and nutritional needs in DPRK.

We can only regret that FDRC does not give such a priority to these needs that it seeks further assistance by Médecins Sans Frontières. As Dr Goemaere explained earlier, amongst others in his letter that you received in the middle of August, the support to drugs production by DPRK itself is not an activity, appropriate for MSF to do.

At the moment of our departure we need to inform the public and the donors of the reasons of our departure and our opinion on the situation in DPRK. That is part of the accountability mentioned above. For that reason a press statement will be issued in which we will not be able to conceal our differences with the government of the DPRK.

We reiterate that we remain available for assistance to the people of DPRK and are willing to return, albeit under different working agreements. At all times we are willing to engage in a dialogue with the government of DPRK on these matters.

Yours sincerely

Dr Lex Winkler - Executive Director MSF Holland

Dr Alex Parisel - Executive Director MSF Belgium

Dr Karim Laouabdia - Executive Director MSF France

INTERVIEW

I was in Africa when I heard we were going to leave North Korea without saying anything. I was sickened because I considered it vital to speak out: there was lots of interest in North Korea and we couldn’t just leave the country without saying anything. It was really weird because for once, it was the Dutch who wanted to make a statement, make a big fuss about our departure, whilst the French were refusing because they didn’t want to talk about it. It became an issue between Pim de Graaf [Operations Director MSF Holland] who said he wanted to make an event of it in Holland, explaining why MSF was leaving, and Jean-Hervé [Bradol, Operations Director of MSF France] and William Bourgeois [Programme Manager MSF Belgium]. Everyone was saying: ‘do what you want in Holland but we don’t want to hold a press conference.’ The French were saying: ‘we can organise a round table to discuss the situation with academics interested in Korea.’

I came back and raised some hell, calling everybody and saying that we were getting it really wrong: ‘what’s going on? You can’t leave North Korea without saying anything in public. It’s inadmissible. It’s a waste of time doing anything in Amsterdam. We should do something in Hong Kong, which is on nobodies’ territory.’ They all said: ‘OK, let’s meet up in Brussels.’ We held this meeting with the programme managers, various communications people, and I don’t know who else. We spent the day looking for agreement and decided that I should go to Hong Kong and organise things. We more or less built up the message, but there were differences between the sections.

We needed everyone to agree in order to do something in Hong Kong. When you do a conference over there, the clocks are ahead and so you make headlines elsewhere. People know about the situation in Hong Kong and it’s easier to manage international subjects in the field where people are informed and interested. During the meeting in Brussels, the French continued to push for using the term famine. The others and I said: ‘OK, fine for famine but everybody’s talking about it, it’s nothing new. The Buddhist monks and every Tom Cobbler and his wife are talking about this bloody famine. And we haven’t got much exciting data about it. On the other hand, what we do have to say is that the international community really has to revise its aid policy for North Korea because we don’t know where this aid’s going. We don’t know where the food aid’s going. And as for the medical aid, we’re not allowed access to follow it up.’

A message with the hook of: ‘think about what you’re doing in North Korea’ was much more political and provoked far more controversy. Everybody in MSF agreed with the famine point but they thought that we should work on the medical aspect above all. It was true. But as the French were in China, to-ing and fro-ing from the border, we said: ‘OK, we’ll do something on the famine. We can’t move around, we have no access for giving medical assistance and we have serious suspicions that there’s an enormous famine, and we haven’t managed to establish where the aid delivered to the country is going. We’d like to know, so people need to look into this.’ That was the message.

Samantha Bolton, Communications Coordinator, MSF International, (in French).

On 1 October 1998, MSF issued a press release and a press conference was held in Hong Kong. Marie-Rose Pecchio and Dominique Lafontaine, members of the MSF team in North Korea, Eric Goemaere, MSF Belgium Executive Director, and Marine Buissonnière member of the MSF China exploratory team to the China/North Korea border took part in the press conference. They presented the reasons for MSF’s withdrawal, the issue of the ‘socially deprived children,’ the experience of the famine, and the discriminatory nature of the North Korean system, as described by the refugees to the MSF team at the China/North Korea border. www.video.14

In most of the western newspapers, the news was published on 1 October. According to some observers and to the press articles themselves, the MSF message regarding the famine issue as delivered during the press conference was unclear. Some commented that the message was even contradictory. Main contradictions were around two things: was there a famine or not? Was MSF kicked out or did it choose to leave? Moreover, there had been leaks in the European and US press. As early as 30 September 1998, the French daily Libération, had published several of the refugees’ testimonies. Also, the US International Herald Tribune quoted MSF on the issue of the socially deprived children. www.video.15

DOCUMENT

“MSF Calls on Donors to Review Their Policy in DPRK - Urgent Needs in North Korea But MSF Forced to Pull Out,” MSF Press release, Hong Kong, 30 September, 1998 (in English).

Extract:

The international medical relief agency Doctors Without Borders/Médecins Sans Frontières (MSF) today announced that it has been forced to pull out of North Korea (DPRK) this week, despite urgent medical and nutritional needs throughout the country. MSF was the largest medical organisation working in North Korea and had tried to negotiate to continue to work in North Korea, to have free access, to assess the needs, to bring humanitarian assistance to those most in need and to monitor its aid. The government, on the other hand, refuses to acknowledge that there is still an emergency and only wants structural support to rebuild the national pharmaceutical industry.

“We are sorry to be forced to pull out when there are serious medical, nutritional and sanitation problems which need to be addressed,” said Dr Eric Goemaere, Director General of MSF. “The new policy of ‘normalisation’ has nothing to do with the reality of life in North Korea and will cost the lives of thousands. What these people urgently need is more effective accountable humanitarian assistance while structural solutions are found to the underlying crisis,” he added.

Since early June, there has been a clear high-level policy change to further restrict and limit effective humanitarian aid, which makes it impossible to deliver aid in a principled and accountable manner. MSF is today calling on all donor governments to review their aid policies towards DPRK to ensure it is more accountable, so that humanitarian agencies can freely and impartially assess needs, deliver aid, have direct access to the population and assess the effectiveness of their programs.

Urgent Medical Needs

• Since the national DPRK production of pharmaceutical supplies collapsed in the early 90’s, most of the hospitals and health centres MSF visited had not had any antibiotics or fresh medical supplies for years. Doctors on a local level estimate that without outside assistance, they were/are around 75% reliant on herbals or traditional medicine.

• There is an unusually high level of hospital admissions among normally young and healthy age groups: around 50% of the patients admitted as in-patients in the internal medicine and surgical wards are between 20 and 40 years old.

• The majority of the admissions to the in patient departments (IPD) are gastro-intestinal (gastro-enteritis, typhoid, diarrhoea), mainly caused by deteriorating sanitary conditions: lack of fresh water supplies; people washing in and drinking from the rivers* etc.

• To counter these infections and to prevent the spread of cholera and other diseases, the government runs mass forced vaccination campaigns against cholera and other diseases. The national cold-chain is not reliable, so people are often only vaccinated in the winter**.

• Among patients hospitalised for gynaecological reasons, around 50% are for abortions. Before MSF distributed standard gynaecological supplies, hospitals were performing caesareans, abortions and other surgical interventions with rusty instruments and without little or no anaesthetic, sterilization equipment, antibiotics or anti-haemorrhagic drugs***.

“There are serious risks of outbreaks of diseases and death from terrible health and nutritional conditions, but there is a problem with the way needs and solutions are prioritized.,” said MSF field doctor Dr Dominique Lafontaine. “While there is an urgent need to restructure the water and sanitation system, the government responds with mass vaccination campaigns against cholera and while there are urgent day to day medical and nutritional needs, the government refuses to allow humanitarian agencies to assist and only focuses on rebuilding the pharmaceutical industry.”

Refugee Reports of Famine

In addition to the medical problems, there are worrying reports about widespread famine in North Korea. Refugees interviewed by MSF in April and August and who recently arrived in China from North Korea, speak of widespread famine, of relatives, friends and neighbours dying of long term and recent lack of food. They also describe discriminatory food distribution systems according to social position and to party loyalty and speak of large numbers of homeless children roaming the countryside looking for food. Giving further cause for concern about the real nutritional status of the population, MSF has been systematically prevented from having full and free access to conduct surveys inside the country. MSF has been negotiating since 1996 with the authorities to conduct reliable and representative nutritional surveys inside the country, but no permission has been given.

Vulnerable Populations

Because of the harsh living conditions, bad sanitation and poor nutrition, there are thousands of orphan children, most of whom are homeless or street-children. MSF is concerned that too many are not being taken care of by the existing health and institutional structures. The local authorities recognize that there is a problem and that they can’t deal with it, but on a central level, the authorities insist that there are no homeless or street children. In ten months, MSF worked in sixty-four feeding centres in four provinces, taking care of around 14,000 children. It was difficult to get information about where the children came from and where they went after treatment. However in one province, South Pyongyan, MSF was able to get more information and estimates that about a quarter of the children, in nutritional programs, which MSF was able, to visit, were orphans or abandoned. Many of them were homeless and were picked up starving from the streets. MSF is convinced that there are certain institutions or places where these children are collected, which are discretely mentioned by local staff, but to which international teams had no access.

Humanitarian Needs vs. Government Priorities

The change of policy in North Korea follows two years during which the government had started to open up and international relief agencies were allowed to address the urgent need for food and humanitarian assistance. However, after considerable financial commitment to the crisis by the international community, priorities seem to have changed. “It is clear that the priority in North Korea is now more to preserve the self-sufficient ideology than to provide effective and accountable assistance to those who need it most,” said Dr Eric Goemaere. Negotiations broke down this month between MSF and the DPRK over the renewal of the Memorandum of Understanding (working contract), which defines what sort of assistance is needed and how it will be implemented. Over the past year MSF had managed to expand its medical assistance programs to support around 1,400 health centres and hospitals assisting seven million people in four provinces with medicines, equipment and training.MSF was negotiating to continue this assistance and to target particularly vulnerable groups such as homeless and orphan children. Instead the authorities insist that the most effective type of medical and nutritional assistance for DPRK be for “MSF to pay deep attention to provide pharmaceutical raw materials****.”

MSF is convinced there are serious medical and humanitarian needs in DPRK which need to be addressed, but adheres to the international humanitarian principles of impartiality and of freedom to assess needs, to assist the most vulnerable, and to assess the effectiveness of that assistance. Dr Eric Goemaere said: “It is not easy as doctors to pull-out when so many people have died and when the health and lives of so many people are still in danger. But in the end, humanitarian assistance can only help those who need it when it is impartial and accountable. This is not the case in North Korea.” He concluded: “Now it is time for the North Korean government to take responsible for the health of its people and to allow direct humanitarian assistance. It is time for the donor governments to ensure that the humanitarian aid that they fund aid is implemented in a principled and effective manner”. The last of the international MSF teams will leave North Korea tomorrow morning, Thursday, Oct 1, 1998, after working continuously for 16 months running drug distribution programs, training programs and supporting therapeutic feeding centres and health structures.

* MSF team members also caught typhoid from food or water.

**There are no internationally recognized effective vaccines against cholera on the market anywhere in the world. In DPRK, UNICEF and WHO vaccinate people against polio, measles and tetanus. The DPRK government runs mass vaccination campaigns against: diphtheria, whooping cough and cholera. The origin and content of these vaccines is difficult to ascertain.

***Standard obstetrics supplies include Dilatation and Curettage equipment with sterilised instruments, antibiotics to prevent infection and homeostasis to prevent heavy bleeding ****Taken from letter sent to MSF Head of Mission by Mr Ri Si Hong, Acting Director, Department of External Affairs of the Flood Damage Rehabilitation Committee DPRK, dated Pyongyang Aug. 24, 1998.

DOCUMENT

“North Korea Feedback,” Email from Samantha Bolton, MSF International Communication Coordinator and Justine Geldard, MSF Hong Kong Press Officer to MSF communication network, 30 September 1998 (in English).

Extract:

- Went really well despite the fact that we arrived at 3 pm on the dot, in a sweat thanks to Hong Kong traffic and the driver getting lost! All participants were really clear and stuck to their brief, which was worked out between everyone this morning. There were a lot of questions and in the end they had to be cut short. The leak in the International Herald Tribune got some of the journalists irritated, especially the US - Boston Globe (but calmed down when MSF was equally irritated by leak) as their papers picked the story up off the Washington Post news service and not from them. However, - the secretary of the FCC said that many told him that they had been alerted by their editors because the Post and Libé were told to go and get the story as it was news. Some correspondents who I didn’t even know were in HK turned up because of this. The Libération leak was disappointing because it took hours to negotiate each word of the press release and then too much went out before, prompting other journalists to leak and to get angry, making it difficult to get anything organised on an international level. A lot of people are upset and say there is no point in keeping embargos despite the fact that overall the impact of what we have done as been very high so far. Also, Marine is worried that the priest mentioned by name and location is going to have his life in danger. Nevertheless, so far the coverage has been better than expected.

DOCUMENT

“Aid Agency Pulls Out of North Korea - Doctors Without Borders Fears That Food Sent For Children Is Misused,” by John Pomfret, Beijing The International Herald Tribune (Washington Post Service), 30 September 1998 (in English).

Extract:

BEIJING - The largest international charity operating in North Korea announced Tuesday that it was pulling out because the Communist government had refused to give the charity access to a large population of malnourished and ailing children. The European charity, Doctors Without Borders, withdrew its team of 13 professionals, including nine doctors. The move, rare for an international organization, underscored the growing problem that Western aid agencies are having in North Korea as they try to determine whether medicine and food are getting to the truly needy in the isolated Asian nation.

In early August, the Paris-based Doctors of the World left North Korea for similar reasons. Officials of Doctors Without Borders said they were concerned that the North Korean government was adopting a double standard - feeding children who came from families loyal to the regime and neglecting those children who did not. The officials said they had obtained evidence that orphaned and homeless children had been collected in centers, known as “9-27 camps,” named after the day last year that the North Korean leader, Kim Jong II, ordered the establishment of the centers to “normalize” the country. Conditions at those camps are believed to be horrible, the officials said, citing interviews with refugees from such centers who escaped into China.

“We are sorry to be forced to pull out when there are serious medical, nutritional and sanitation problems which need to be addressed,” said Eric Goemaere, director general of the organization. “The new policy of ‘normalization’ has nothing to do with the reality of life in North Korea and will cost the lives of thousands.” The medical charity announced its retreat from North Korea just weeks after the United State committed itself to increase donations of food to North Korea by 300,000 tons, making the United States by far the biggest international supporter of the program to stop a food crisis that, according to a US congressional delegation’s report last month, is killing 300,000 to 800,000 North Koreans a year. The U.S. decision met opposition from aid officials, who questioned the ability of the World Food Program and the five American charities in North Korea to monitor the food deliveries. The Tuesday announcement detailed a string of setbacks suffered by one of the world’s most respected aid agencies in its attempts to crack North Korea’s system and help suffering children.

Aid officials said that, compared with European charities, the Americans had been even less successful in ensuring that the aid was not going to Communist Party loyalists or to the army.

Western aid officials have privately criticized the United States for sending food to North Korea as a vain attempt to ensure that the volatile Communist state would not collapse or undertake military adventures – such as attacking South Korea, where 37,000 US troops currently patrol the demilitarized zone along the North’s border. “It’s a bribe, nothing more,” said one aid official. “But if you don’t insist on better monitoring, very little of the food will go to the needy. It will go to loyal party people and the army.”

Dominique Lafontaine, a French doctor who has been based in North Korea since August 1997, said Doctors Without Borders had fed 14,000 malnourished children in therapeutic centers during his time there.As they conducted inspections, health officials noticed that some of the children were extremely malnourished while others were relatively healthy. When they asked about the malnourished ones, they determined that they had been collected in “9-27 camps”. The North Korean leader established the camps, aid officials said, as part of a police action to force millions of people who had left their villages in search of food to return to home. The people are arrested, incarcerated in camps and then sent home, where they are incarcerated again, according to Western aid officials. “We have asked for access to the places where the children are, but we were refused,” Dr. Lafontaine said. “Local authorities confirmed that there were many homeless and orphaned children but when we asked the central government, they denied that they existed. The plight of these children concerns me deeply.” Officials of the charity said that North Korea needed to allow aid officials to conduct a nutritional survey of its children throughout the country. A survey begun Sept. 21 by UNICEF, the European Union and the World Food Program will not be allowed to enter one-third of the country. One Western aid official expressed concern that Unicef risked being tricked by the North Koreans into reporting that things were much better than they seemed. “Then they will ensure that the limited aid will go to the right kind of children,” he said.

DOCUMENT

“North Korea: Accounts of a Hidden Famine – Communist Korea Has Become the Hell of Hunger – Médecins Sans Frontières is Pulling Out of the Country and Denounces the Diversion of Humanitarian Aid by the Regime,” Romain Franklin, Libération (France), 30 September 1998 (in French).

Extract:

Médecins Sans Frontières (MSF) has had to announce its definitive departure from North Korea. The humanitarian organisation, which in 1995 was the first NGO to attempt stemming the famine raging in the country, now says that it is aware of having been ‘manipulated.’

Anxious to attract international aid in order to reinforce a bankrupt Stalinist regime, the communist rulers have since let numerous other charitable organisations into the country. But Pyongyang only lifts up a tiny corner of its veil on the horror experienced on a daily basis by the population. Up until now, NGOs providing aid have been obliged to buckle to the conditions imposed by the dictatorship. Conditions which for many are contrary to humanitarian ethics. According to MSF, not only is aid diverted by the powers that be, but also, in addition, this international effort leaves the most needy completely in the cold.

A country in agony: to find out what’s really going on in this country, a past master in the arts of disinformation and propaganda, the NGO had to carry out surveys on the border separating North Korea and China, the first in April, the second in August. MSF teams questioned refugees on the Chinese side. Their accounts describe a country in agony: factories closed, populations moving out to the countryside to avoid starvation, but, finding nothing there, they end up dying in a torpor; their bellies empty, alongside hundreds of others. The army collects the bodies of the starved or victims of typhoid from the sides of the road, burying them in communal pits. Crowds of starving people huddle up together in the train stations.

“At least several hundred thousand people have died of hunger or disease linked to famine,” according to MSF.

MSF told Libération that it “had no further doubts” that during the last three years “at least several hundred thousand people” had died of starvation or diseases linked to famine. Other non-verifiable estimations talk of 3 million dead since 1995 in this country of 23 million inhabitants. The North Korean region apparently retains its estimation of last year [...] 134 deaths. At the same time, Kim Jong-II’s regime continues to maintain one of the biggest armies in the world and is spending a colossal sum this month on an attempt to put a satellite in orbit for the diffusion of “immortal revolutionary songs” to the glory of its ‘Great Leader.’ These are just a few of the grotesque aspects of a system in where, at the same time, the smallest political deviation is translated into never-ending punishment for its author and his family, often extending to the most far-removed cousins.

Surveillance

Until last week, MSF had a team of 13 people in the country, having started working in North Korea in 1995, first of all for 6 months and then on a permanent basis from July 1997 on. Despite its presence in several provinces and its insistence on working ‘on a grass roots level’, MSF became conscious of the fact that it could barely be anything other than a supplier of food aid and medicines. The NGO realised, amongst others, that it could not, until last spring, form an idea of the real scale of the famine. Médecins du Monde, banging its head against the same obstructions after 6 months in the country, pulled out in July. Watched over permanently by the regime’s officials, MSF volunteers could never meet people for free discussions. “We had to ask permission a week ahead for visiting dispensaries,” related a programme manager for MSF. “When we got it, we had the impression of visiting a Potemkine village where everything was set up.”

“We had doubts about our work right from the beginning, in 1995” relates François Jean, Director of Research in MSF. MSF is convinced there is a total lack of conformity between humanitarian principles and the regime’s objectives. “Humanitarian aid aims to provide assistance to the most vulnerable, whereas we have every reason to believe that aid arriving in the country and channelled by the regime never reaches these people.” Several experts suspect that the North Korean regime uses, as a basis for calculating its food rations, a scale for classifying the population consisting of three main categories and some fifty sub-categories. The families of “counter-revolutionaries” are at the bottom of the scale, and the system’s highest-ranking officials are at the top of it. “The North Korean authorities’ priority is to make the regime last, and whoever serves no purpose in this regard is exposed to the danger of death,” explains Pierre Rigoulot, a specialist on the country.

The floods of the last three years have only played a minor role. “This famine” confirms François Jean, “has a very marked political dimension. On one hand it’s the result of policies carried out over the last fifty years, and on the other it’s been caused by the regime distributing the few resources it has according to criteria reflecting political loyalty and people’s social and economic utility. So concretely, the inhabitants of Pyongyang (who are, as such, privileged), the military and the senior officials always benefit from food distributions whilst those people considered politically disloyal due to their family histories, or who could bring in some revenue, are deprived of all distributions, apart from the two or three kilos of rice provided two or three times a year on the occasion of the Great Leader’s birthday or the founding of the Workers’ Party.”

Widespread bankruptcy

“This type of famine is unique,” continued Jean. Contrary to all the famines of the twentieth century, it isn’t linked to a war situation. Contrary to those of the communist systems (Ukraine in 1932 or China in 1959-1961), it isn’t linked to a frenzied transformation of the recent social order, but to a problem with the structural order. It’s happening in a mainly urban society of an industrial nature (even if the industries are bankrupt). The worst affected categories are the inhabitants of medium sized towns working for collapsed businesses that hold no interest for those in power. “This famine is also the consequence of a general bankruptcy of the economy” added François Jean. “But everything leads us to think that this bankruptcy will not, at least in the short term, lead to a collapse of the regime.” In the meantime, thousands of people continue to die.

Accounts of daily horror

The terrible daily reality of the ‘hidden famine’ raging in North Korea can no longer be doubted. The accounts published here were collected by researchers mandated by Médecins Sans Frontières in August on the Chinese side of the Sino-Korean border. They corroborate another MSF study carried out in April. Refugee accounts are often the first to ‘expose the truth’ on closed-off regimes. This was true for the Khmer Rouge genocide in Cambodia in 1975-1979 (2 million deaths), described right from the first months in testimonies collected by Father François Ponchaud. It was true for horrors in China during the 1959-1961 famine (25 to 30 million dead), described to the western press by Chinese refugees; or for the cultural revolution of 1966 – 1976 (30 million victims of diverse status), brought to light by the China expert Simon Leys who questioned Chinese refugees who swam as far as Hong Kong. Today, it’s true of the North Korea refugees who crossed the river Yalu, separating North Korea from China. Two of these accounts refer to cannibalism. Even if they should be handled with care, it should also be born in mind that cannibalism was practiced during a comparable event, the big Chinese famine of 1959-1961, as attested in a recent book by Jasper Becker, the Great Famine of Mao. [...]

“I come from the town of Hvesan, just over the border from China. I got over the Sino-Korean border by crossing the Yalu, which isn’t very deep, in July ‘97. I was employed in a state-run company. When my company gradually wound down its production, I found myself with no salary. I saw people dying of hunger around me, but it didn’t really affect me. Then my 5-year-old son died of hunger too. That changed everything [tears]. My situation isn’t unique at all. It was the same everywhere, and Hveshan, on the border, was one of the better off towns. Last June, a distribution of one kilo of rice per family came out of the blue. I asked where the rice came from. I was told: just take it and mind your own business. I thought it must have come from international aid. It was the only time it happened. Most aid goes to the army’s officer ranks and the government; it never reaches the common people. Those who have a bit of money get rich and do business; the others die of cold, hunger and disease. There were epidemics of cholera in Hvesan. The hospitals were empty and the medicines were no more free of charge than the food. Just as the factory workers dismantled state companies and sold the metal piece by piece, the doctors sold their working tools too. Hospital medicines were sold in the market and the hospital stocks were empty. Doctors have to survive like anyone else. More and more people were leaving their towns to head for the countryside in search of food. The train stations were packed and the dead were piling up, especially old people and children; to such an extent that the train stations in the area were shut down. Bodies in the streets were a daily sight.”

“I’m a priest in the church of Hungcun. I’ve been going to see my brother in Xinouzhu (in North Korea) in January every year since 1992. There was no free market in Xinouzhu five years ago. Now everybody gathers at the market, because it’s the only place to find supplies. Starving people, with no strength left, are sitting or lying on the ground. There are children everywhere, really thin with blackened, damaged skin. They’re hardly wearing anything. In the market, people are selling bowls of rice for exorbitant prices. I’ve seen people dying in the streets. Dying of hunger and cold. People are hardly wearing any clothes, no socks. no leather shoes. When I visited my brother in January, I saw seven children frozen to death. They’d taken shelter in a pigsty. They were all squeezed up together, huddled up, half naked, and they’d frozen during the night. I saw them. The army uses a metal box for collecting bodies, transporting them to a pit where they’re dropped in the ground. The box is re-used for the next batch of bodies. Collection normally takes place at night. You can’t imagine how far this society has sunk into violence. I’ve seen children literally have bread stolen from their mouths by their elders. The months of April through to September will be critical, as they were in 1996 and 1997. It’s not surprising to hear about cannibalism in these conditions. It’s possible that 15 to 20% of the population is literally dying of hunger, and 5% of it is living decently.

Couple aged 68 and 63 years old, interviewed in Yanji: “one day, my son stated that he did not join the army to steal from people. He was shot on the spot.”

Young people of 19 to 25 years old, Yanji: “really thin children wander around, stealing to feed themselves.”

Couple, with one child, Yaniban district: “we were told that foreign medicines made us ill.”

“There were a lot of children sitting around with no strength left. Their heads were puffed up out of proportion and their eyes were barely visible. Their legs were swollen, sticking straight out in front of them like pillars from the top of their thighs to their ankles. Their skin was blackened and they had skin infections all over their bodies. In winter, they passed away from cold, but in the summer they stayed haggard and lifeless for days on end. There were thin, exhausted adults too. In the parks in the next town along, bodies were left lying around for up to two or three days before being collected. The propaganda was raging. We were told that we had to tighten our belts in until 2003, that our efforts weren’t sufficient yet. Korea’s far too proud to admit to foreign aid, it would loose face. So we were told that clothes coming from China carried viruses, that food coming from international aid made us thinner and that foreign medicines made us ill! [...] Everybody was ill, more or less: diarrhoea, stomach-ache, typhoid and para-typhus, and cholera. Finally, when people died, we didn’t say that they’d died of starvation or sickness.”

Military, 35 years old, and his son, 9: “aid is first of all distributed to the army, then to senior officials.”

An 18-year-old North Korean and his 8-year-old brother: “orphans become hunted objects.”

“We were a family of four children (25, 18, 15 and 8 years old), originally from the neighbouring village of Ham Hung. Our father died of hunger three years ago and our mother of disease shortly afterwards. Our sister’s two eldest children died of hunger at 1 and 4. We were eating grass and roots. What’s more, the lives of abandoned children, without parents, were always dangerous. Not only was there no pity for us, we became hunted objects: our neighbour killed, salted and ate an orphan that no one had taken in.”

DOCUMENT

”North Korea - Famine - MSF MSF Calls for a Revision of Aid to North Korea,” AFP (France), Hong Kong, 30 September 1998 (in French).

Extract:

Médecins Sans Frontières (MSF) called on Wednesday for donor countries to revise their aid policy for North Korea and impose control on the use of food aid. Dr Eric Goemaere, Executive Director of MSF, explained that since the beginning of June, the authorities of the communist country have modified their policy at the highest levels for restraining and limiting humanitarian aid. The humanitarian organisation, whose final member left North Korea on Thursday, was informed that this communist country was capable of a return to self-sufficiency and instead of medical aid; it would like to receive basic materials for the State’s pharmaceutical laboratories.

“During the renegotiations for our collaboration agreement, we were unexpectedly asked to withdraw our teams from areas outside the capital and stop the distribution of medicines. We were to continue to programme from a central level,” added Dr Goemaere. “But we don’t work like that and we couldn’t reach an agreement” he explained. “The government’s priority is obviously to show an image of self-sufficiency, rather than provide effective aid to the most needy,” added the General Director of the humanitarian organisation. “We are now asking the donor countries to change their aid policy in order to increase pressure on the government and ensure that in the future organisations like ours can return to the field,” declared Dr Goemaere.

MSF, present in North Korea for two years, was covering 1,400 health centres and hospitals in this country ravaged by famine. The humanitarian organisation was supporting health facilities in North Korea and providing nutritional assistance, with a team of some thirty people in the country. Last April, the MSF office in Beijing, having collected multiple testimonials from North Korean refugees, revealed that ‘almost none’ of the international humanitarian aid was reaching the victims of the famine. The North Korean state, according to these witnesses, stopped supplying food rations to the population some three to five years ago.

DOCUMENT

”Testimonies of North Korean Refugees Talk of a Serious Famine,” Pierre Antoine Donned, AFP (France), Tokyo, 30 September 1998 (in French).

Extract:

TOKYO, 30th September (AFP). The famine is serious in North Korea where an important part of its population is dying of hunger or diseases linked to malnutrition, according to testimonies collected by Médecins Sans Frontières and made public on Wednesday. Some twenty North Korean refugees were interviewed between April and August this year along the Chinese border with North Korea, with two thirds of them originating from the north of the country, which is cut off from the world and affected by an unprecedented food shortage. “The situation is extremely serious. There’s no doubt about it,” explained Marine Buissonière, Administrator for MSF, in Hong Kong, interviewed by telephone from Tokyo, the day MSF announced its withdrawal from North Korea. “We have no doubt about the sincerity of the people we interviewed, even though it’s impossible to verify what they’re saying,” she added, explaining that she had taken part in these interviews in person, in different parts of northeast China along the border with North Korea. “The people we spoke to had all lost one, two or three members of their families, dead from starvation or disease caused by malnutrition” she said. “Several of these refugees talked about cannibalism, but we’re not in a position to confirm these statements ourselves,” added the MSF representative.

According to these witnesses, it isn’t unusual to the see starved bodies lying in the parks of certain towns for up to two or three days before they are removed. The North Korean towns close to the border with China receive groups of starving North Koreans who arrive by foot from the interior of the country in the hope of crossing the border with China, where they can at least stave off their hunger. In these towns, “we see people arriving in groups, haggard children and adults. There are under-nourished children with enormous heads, legs stiff as pickets and blackened skin,” related a 30-year-old refugee who claims to come from the border town of Hysan. “A lot of people die in winter. In the summer, people lie immobile all day, staring fixedly into nothing” she said.

MSF questioned two brothers of 19 and 23 who said they’d crossed the Chinese border via the river Yalu on the 29th of last July, following hours of walking and avoiding road checks. Originally from Musan, near the border, they explained that they’d lost an older brother to starvation in 1997, aged 22, and that they’d managed to survive by collecting shells and seafood, which they sold at the market. They explained that the situation started to deteriorate in their region at the end of 1993. The distributions of food rations became irregular, then sporadic, perhaps once every three or four months from 1995 on. Rations were distributed on national holidays. The inhabitants then received two days of rations, being 1.2 kilograms of rice or cereals per family, they said.

International aid, according to witnesses, rarely reaches its destination. In some 70% of cases, it goes to the regime’s senior officials and the army, with only the remainder reaching the devastated population. MSF announced in Hong Kong on Wednesday that it was pulling out of North Korea where it has been one of the main international charitable organisations. It considers that it cannot carry out its mission correctly due to the obstacles posed by the North Korean communist authorities. For their part, on Wednesday UNICEF and the World Food Programme (WFP) of the UN declared that they could not confirm MSF’s accusations on the diversion of aid and added that they did not envisage pulling out of North Korea. A delegation from the American Congress last month evaluated the number of deaths caused by the famine at between 300,000 and 800,000 per year. North Korea is going through an acute economic crisis following floods on the back of successive droughts, which have already derailed the country’s economy.

DOCUMENT

“Policy Change Forces Out Relief Agency, Leaving Famine Victims to Their Fate,” The South China Morning Post, 1 October 1998 (in English).

Extract:

International relief agency Médecins Sans Frontières (MSF) said yesterday it had been forced to pull out of North Korea. The French-based group urged donor governments and multilateral agencies to review aid policies to the North and demand greater accountability from Pyongyang authorities. MSF director-general Dr Eric Goemaere said since early June there had been a clear high-level policy change to restrict humanitarian aid in the famine-stricken country. MSF, which had been supporting 1,400 health centres and hospitals, was told North Korea was able to return to self-sufficiency and instead of medical aid it wanted raw materials supplied to its state pharmaceutical factories. ‘It is clearly more a priority for the Government to show an image of self-sufficiency than to provide aid for the most vulnerable,’ Dr Goemaere said.

Since the early 1990s hospitals had been about 75 per cent reliant on Korean herbal medicines, which were useless against serious diseases, the agency said. Dr Goemaere said it was difficult to confirm reports of widespread famine. MSF said it was convinced food and medical aid was being distributed along political lines, with party faithful receiving food as others starved. It also expressed concern about the number of orphaned and homeless children wandering the countryside in search of food. Dr Goemaere said authorities had told the agency that homeless children were not a priority. MSF said it had discovered an unusually high level of hospital admissions among the young.
Dr Goemaere said MSF’s withdrawal could throw the country back ‘almost into human experimentation’, meaning doctors did not have drugs to treat serious diseases and if they did have the supplies, they did not know how to use them. He described horrific conditions in provincial hospitals, where doctors were performing operations without anaesthetic, sterilisation or antibiotics. Old beer bottles were being used for intravenous drips. The last of the 14-strong MSF team will leave North Korea today after 16 months.

DOCUMENT

“Aid Agency Quits North Korea,” The Guardian (UK), 1 October 1998 (in English).

“North Korea Rejects Medical Aid,” The Independent (UK), 1 October 1998 (in English).

“Aid Agency Forced Out,” The Times (UK), 1 October 1998 (in English).

“Aid Agency Suspends Operations in North Korea,” The Telegraph (UK), 1 October 1998 (in English).

DOCUMENT

“Charity Forced Out of Korea,” The Irish Times (Ireland), Hong Kong /Paris, 1 October 1998 (in English).

DOCUMENT

Minutes of MSF France Board of Director’s Meeting, 30 October 1998 (in French).

Extract:

Denis Pingaud [Director of Commu-nications and Development since July 1998] was struck by the profound differences existing within the MSF family on the understanding of what MSF is about. According to him, MSF F shouldn’t follow or reject the international movement, but rather fight the ‘World Company’ culture, which is taking root within the organisation. This culture involves the belief that international consensus is more important than taking important decisions if they generate disagreement. Take North Korea, for example. The fundamental issue is the content of the message with regards to the population. The need to agree amongst sections to deliver a common message in the name of MSF International is only a secondary issue. A communication hiatus between two sections is not a big deal if it allows a strong message concerning populations in danger to emerge. The frenetic search for a common message can be seen throughout society and bears the name of globalisation. It responds to an ‘international label’ mentality and does not reflect the true sense of an action.

INTERVIEW

We arrived in Hong Kong. We’d decided that the last team would close the North Korea mission and leave the same day, and we’d do this press conference. We finalised the message. There were the standard discussions with thousands of phone calls all over the place. We compiled the different witness accounts, press releases etc. The idea was, as usual, to have a message under embargo, which would be released when the team left Korea. We could feel that the French really wanted to push their famine message and I was a bit scared they’d make a pre-emptive strike because if we say something in Hong Kong in the morning, we’re ahead of everyone in Europe. I suspected Paris of planning to release something. I had to fight to have journalists at the press conference because it was the day before a long weekend. I spoke to John Pomfret, the Washington Post correspondent in Peking, who was really interested in the story and I sent him the report the evening before, thinking that it was too late for publication deadlines, but I wasn’t completely sure.

Obviously, it was published in the Beijing edition of the Herald Tribune the same day as the press conference. So we broke the embargo. Our message was: ‘the donors should think carefully about what they’re doing because there’s a famine and we don’t know where medical aid’s going.’ In the meantime, Paris has sent its dossier to the Libé, which said: ‘there’s a famine and thousands of deaths.’ So there were two different messages, more or less. One which was more on the medical issues, mentioning the famine but above all being highly political, and the other which was completely focused on the famine. We received insulting faxes from all over the place because the teams were already informed. They’d heard that it was going to come out in the French press and the Herald Tribune and they asked what the hell was going on. Eric and the rest of the team were panicking because there was still an expatriate in Pyongyang and the message was going to come out before she’d caught her train. They said that they didn’t want to do the press conference, it was impossible to work with the French; they were always doing stuff like this, etc. I tried to calm the crisis down – it was total bedlam – saying: ‘who cares, it’s just a little French newspaper. It only interests you because you’re Belgian, but in reality it doesn’t count for anything on a worldwide level. It’s the Herald Tribune that matters, and the Washington Post that everyone reads. Look at the message; focus on the message, that’s the message. We don’t care about those damned French!’ […]

In addition, I’d set up some prior interviews with Eric Goemaere which were all under embargo, and all these people who had waited for the embargo to be lifted suddenly found themselves confronted with an article published in Peking. I received some really offensive calls from journalists who were furious because their editors were saying: ‘It’s already out in the French press, the Herald Tribune. You’ve missed the boat. You’ll have to go to the press conference.’ So there were loads of journalists at the press conference and they were furious with us. I was insulted by them all. And then the team lost the plot, dragged its feet; didn’t want to go anymore. And Eric Goemaere was livid….

We took two taxis. We crossed Kow Loon [the part of Hong Kong situated on the continent, where the MSF office was located at the time] and I don’t know what was going on with these new Chinese taxi drivers [Hong Kong had become Chinese territory again on 1 January 1997] but they didn’t understand anything and they took us to the old press centre, which no longer existed. I just couldn’t make myself understood with the taxi driver, who only spoke Chinese, and we’d lost the other car, I didn’t know where Eric Goemaere was and we were late for the press conference: it was mayhem! Finally, we got there ten minutes late. The journalists were hopping mad. They almost spat in our faces. It was a holiday and they were all in a hurry to leave. We finally got started. It went really well. They were all great. Eric adopted the political message we’d agreed on. We talked about the famine, medicines and our incertitude concerning the destination of aid. Which was the real scandal in this whole affair. There were the orphan stories - they made their mark as well. Marine really said everything there was to say about the famine, the witness accounts etc.

On listening to all these testimonies, it was really obvious that it was total chaos in North Korea, that the famine was a consequence of all the other dysfunctions. What they said built up a global picture of a country in chaos, which had completely lost control, was starving. It wasn’t totally balanced because these observations were only made from China and we didn’t have any data. And in addition a lot had already been said about the famine. It was interesting that MSF was repeating it, but it wasn’t new. What did interest people was what was going on inside Korea. What we’d seen. The orphanages were in shambles. The fact that we couldn’t move around, that we couldn’t find out where our medicines were going. The fact the authorities wanted us to re-launch the pharmaceutical industry. We were really clear that we’d been manipulated, that our aid had been manipulated.

The journalists were interested in what we had to say. They listened to everything and asked some questions. The room was full. There were television cameras at the back and some thirty journalists from the world over. Eric took the opportunity to say the complete opposite to the French message published in the Libération, to set the story straight. It was Eric Goemaere; the Executive Director of MSF and his message was not primarily focused on the famine. Paris went nuts. I said to them: ‘too bad. You didn’t respect the embargo. You didn’t follow the message exactly as we agreed. But it’s not a problem because everybody took up our common message and that’s the one in circulation.’ It was a bit of a war between the sections… just for a change… but it was really funny. The French had their opinion. They wanted to try and do it their way, in the French press. But it didn’t matter too much because in the end, the message adopted by everybody was the message we’d decided on in Brussels. Too bad for the two papers in France.

We were on television throughout the region, CNN etc. It worked very well. The message was really strong and allowed WFP and diplomats to be asked for help later on. There were lots of discussions afterwards. The fallout went on for a while, with interviews, opportunities to explain ourselves etc. I had to give a 15-minute television interview with an ex-ambassador in London, for example.

Samantha Bolton, Communications Coordinator, MSF International, (in French).

INTERVIEW

I’d been in regular contact with Romain Franklin of the Libération for some time. He’d been following Korea for a while. I saw a lot of him; we trusted each other. That’s how I functioned when I was a Programme Manager. I had regular contacts with journalists, I followed their work, I knew what they were working on, and I kept them informed from my side. In this case, we knew the story was ‘big’ for the Libération, but we didn’t know what they’d do with it, we didn’t know if it would make headlines. It was a bit like with Zaire . We didn’t know from the outset, but we knew the circumstances were favourable. There was a link with the press conference in Hong Kong. But the Libération dossier was more substantial because the journalist had been kept informed for a while and he had all the documents.

The subject of the press conference was our withdrawal. Marcel arrived on the 30th September with a subject that was in no way related, being ‘the situation in North Korea as seen by refugees,’ and, this automatically reinforced the effect of announcing our withdrawal. Our timing was good here. When we look back at it, we always have the impression that the different stages were well planned, but actually it was much more off the cuff. And there were windows of opportunity. Romain opened one up. We jumped on it and it caused waves. The refugee accounts fed the basis of the dossier. At the time, there were few organisations considered independent who did this sort of work. So in France, this reinforced our position when we were talking about Korea: MSF is leaving, and the refugees confirm what we can’t see from the inside.

Pierre Salignon, MSF France programme manager, from October 1997 on, then MSF France Executive Director from January 2004 on.

INTERVIEW

MSF decided to leave North Korea and organise a press conference to take place in Hong Kong. Three people were there to present MSF’s position: Eric Goemaere presented the official institutional position, Dominque Lafontaine, the MSF team’s doctor in North Korea described the incapacity to assist children, especially in the north of the country, and I talked about the refugees. I was sent by Marcel [Roux, Coordinator for MSF France in China]. We said that there were urgent needs; that the refugees reported the existence of a famine, that the humanitarian needs were considered a priority by the government and that we were leaving. Most of the questions were for Eric Goemaere. Dominique and I were very much in the background; we were the ‘beginners.’ The main message was carried by Eric; Dominique and I came to prop up it up.

During the press conference, I noticed a kind of contradiction between what Goemaere and I were saying. He couldn’t bring himself to use the word famine. As for me, I wasn’t bearing a message regarding MSF’s position on the inside of North Korea, but I was obviously in a legitimate position to pass on the refugee’s accounts. I had the vision of these refugees in my head, so I was more radical on the issue. I was familiar with them, I felt comfortable with how this information had been collected, and I had met sufficient numbers of refugees who’d described the reality to me. I reported what they had to say. I don’t think I passed an institutional message for MSF. Eric Goemaere was there for that and I don’t remember working totally against him. Nonetheless, relating the witness accounts allowed me to go further than Eric Goemaere or Dominique Lafontaine.

Our message ended up being a sort of compromise. We wanted to protest and say that we couldn’t work inside North Korea, that aid was being manipulated, and at the same time we had trouble being strong and clear in our messages. We were missing clarity; it was obvious that we had difficulties putting our message together. In the end, we asked for external pressure on North Korea to be stepped up so we could have access. When a journalist asked if a famine existed in North Korea, Eric replied that we didn’t know, which was precisely the problem. I had the impression that you could feel this internal ambiguity in the contradictory articles published following the press conference, some saying that MSF had talked about a famine, others saying that MSF said there was no famine. It showed our unease on the subject.

Marine Buissonnière, administrator, MSF France in China, December 1996 to January 1999 (in French).

INTERVIEW

Kong. I was really uncomfortable with being obliged to speak out. I didn’t really want to talk about it like this; my English was never very good. I was supposed to represent someone from the field. I didn’t manage to say much. We mostly passed the basic message, i.e. there was very little humanitarian working space, and humanitarian aid wasn’t reaching the populations needing it. The children’s story was not discussed. We’d been contacted by journalists before the press conference. Samantha Bolton, who was managing the occasion, had asked us to give an interview because the journalist in question couldn’t come to the conference. He wanted to talk to us directly. We talked a bit about all these stories. Afterwards it caused a riot because we’d agreed he would only publish his piece after the press conference, but he did it before. Everyone was annoyed about it. I saw the article in the International Herald Tribune, published before the press conference. This journalist already had a lot of information and was very familiar with the situation in Korea. He distorted our words a bit - we didn’t want to talk about things in detail, and in the article he published, he put down things that we never even said. He dated the story the 27th September, which was before we’d even spoken. I haven’t really trusted journalists since.

During the press conference, we kind of patched together two ways of looking at the situation. There was, nonetheless, an agreement to deliver a message coming from MSF. Marine came with her message. From their side, they presented some information collected on the border, which described the reality in the field, including aid diversion. The refugees who’d passed to the Chinese side claimed that they’d received nothing; that they’d had no access to aid. If on one side people who’ve left country say they received nothing and on the other side people inside the country say they’re distributing, there’s a problem. It was incoherent with their analysis, which concluded that everything was being diverted. I was astonished because there was the press conference itself with the official remarks from Eric and Marie-Rose but hardly any journalists asked questions afterwards. They focused on Eric, undoubtedly because his discourse hung together well. But I don’t suppose anyone was interested in the testimonies on what was going on in the field, inside North Korea. They didn’t come out at all in the stories published by the press. I said that we were in the field, outside the capital, everyday, and I described what we could see. Maybe I didn’t express myself very clearly in English and no one understood.

Dominique Lafontaine, physician, MSF Programme in DPRK, August 1997 to September 1998.

INTERVIEW

The testimonies of Marcel Roux’s team bothered me for our overall image. At this point our messages became a bit contradictory. We were working towards an agreement. We said: ‘whatever we do, we won’t manage to improve the situation because the rules of the game aren’t respected.’ Then Marcel showed up saying: ‘there are millions of dead.’ If you come back saying there are millions of dead, then you must follow up by saying: ‘so we have to be there, whatever the conditions.’ Yet he was clearly saying that the country should be flooded with food aid, that obviously the military would be fed as a priority - the famous million members of the military - but once they’d had their fill, what was left would go to the general population. According to him, the country should literally be bombarded with food aid, which was completely contradictory with what we were saying. I don’t know if I’m right. But I can see the clash between a kind of field spontaneity and our attempt to apply some strategy to this witnessing. We encourage people’s spontaneity in MSF. It’s a good thing - no party line, no spokesman. But there comes a time when we are totally incomprehensible, and here, once again, we were totally incomprehensible. We were applying pressure for the coordination of aid, saying that otherwise it wasn’t worth giving. Then suddenly Marcel arrives saying: ‘we have to shower the country with aid.’ Honestly, once again people outside MSF were asking themselves: ‘do these guys know what they want?’

Dr. Eric Goemaere, Executive Director MSF Belgium, (in French).

INTERVIEW

They spoke of 2 million dead due to the famine. I don’t know if it’s true. But 2 million dead don’t just disappear like that. Our message was really weakened by all this confusion. I think it was a good one, but we missed the mark. The problem was that we were saying things we couldn’t prove. I have no problem with saying that there’s a famine in North Korea but we’re a big organisation, people listen to us, we have to use our visibility with intelligence and say things we’re sure of. The French were launching ideas into the air without being able to prove them. I think I was in China at the time. The story was taken up on a regional level and I was obliged to contradict Marcel, saying that there were unconfirmed rumours but this wasn’t MSF’s opinion, we had no proof. Eric left for Hong Kong when the article came out in the press, and he did the press conference.

William Claus, MSF Belgium programme manager, (in French).

INTERVIEW

We did some good work on the absence of access to the population and the lack of control over the food distribution. We had a lot of press coverage. Once again, we really challenged the government. The message was generally well received [outside North Korea]. We were really clear when we said: ‘the reasons why humanitarian aid is provided to North Korea on such a massive scale are political.’ Saying that international aid was worth half a billion a year and having no impact because it wasn’t divided up fairly, talking about the importance of evaluating needs, all these things relating to totalitarianism, they made waves. Others were saying it too, but we were the only ones in the humanitarian community to be raising the issue. And that was the value of our speaking out. We had the legitimacy to do it. I was completely at ease with all this. It was really useful and effective in terms of raising awareness. We did a great job. I think it’s an example of a campaign that worked. The sad thing is that it’s the sort of campaign that works because we’re leaving…

Anne-Marie Huby, Executive Director, MSF UK (in French).

INTERVIEW

There was this article by John Pomfret of the Washington Post. There were three editions of the International Herald Tribune, [which re-published articles from the Washington Post and the New York Times]. One in Hong Kong, one in Paris, and one in New York. We actually announced our departure in the Hong Kong edition, i.e. before announcing it in New York [due to the time difference]. It was perfect announcing it in Hong Kong. It seemed really logical to me, as this was the region concerned. But it caused a real hiatus. MSF Belgium wanted to stop giving us information. They said: ‘our agreement on communication has been broken by MSF USA, because Hong Kong communicated before us, etc.’ They really gave us a hard time on this point. I had Marie-Rose, the Coordinator, on the telephone. She reproached me, saying: ‘and you, in New York, you were involved, etc’ and she didn’t even want to speak to me anymore. I had to pull out all the diplomatic stops to get information out of her - I had to communicate with her directly to understand what was going on.

Antoine Gérard, Head of Programmes Department, MSF USA, (in French).

INTERVIEW

I don’t think that we have done anything else except emptying our own emotions and that was it. We emptied our souls and our emotions by these perfect statements and I still think that it was completely useless. Now it looks like we went in, we tried, we were naively surprised by the lack of progress, and then we decided to turn our back on North Korea. There was obvious manipulation of information to us. We had information coming from the Chinese side and there was even done a sort of field visit - assessment - two missions -assessment missions on the Chinese side and among North Korean refugees. And their information was that many people in North Korean were dying from hunger. And our information from within North Korea was not at all like that. We never witnessed signs of any kind that on a large scale, people were dying. So we have always said, either, they are so skilful at manipulating our information that even if you are very suspicious, you do not see the real side, or the témoignage from the North Koreans who say in China, that so many people have died, is false. One of the two: still I find it very difficult to believe that so many North Koreans have died and that MSF people in three different provinces and later four did not witness any sign of that. But we do have many concrete proof of the fact that our information was manipulated. But if 10% of the population had died during that time, as was claimed, we would have seen fresh graves. We would have seen some people dying. We never saw people dying in hospital. So, that is why I think that both our information was manipulated.

Pim de Graaf, MSF Holland Executive Director (in English).

On 30 September 1998, while the nuclear and peace talks regarding the Korean peninsula were about to resume, the USA promised to provide more fuel oil to DPRK. The USA also asked the North Korean authorities to solve the issue of the access in order that MSF could resume its activities, but the US continued with the provision of 300,000 extra tonnes of food aid to the DPRK.

DOCUMENT

“US Gives N. Korea Fuel Oil as Talks Resume,” Carol Giacomo, Reuters (UK), Washington, 30 September 1998 (in English).

Extract:

The United States on Wednesday made good on a promise to provide more heavy fuel oil to North Korea as key talks were set to resume on Pyongyang’s missile sales and on bringing peace to the Korean peninsula. Circumventing a reluctant Congress, President Bill Clinton used presidential authority to provide an extra £15 million to buy some 150,000 metric tons of fuel oil, US officials said. The funds are being shifted from anti-terrorism, non-proliferation, and other programmes to allow the United States to fulfil a commitment to the reclusive Stalinist regime under a 1994 nuclear accord called the “agreed framework,” the White House said in a statement. “We continue to believe very strongly that it’s important to go forward“ with the implementation of the agreed framework,” State Department deputy spokesman James Foley told reporters. “And it is essential in this regard for the U.S. to live up to its commitments just as we demand obviously that North Korea fulfil all of its obligations under the agreed framework.” The announcement came one day before the United States and North Korea were to resume talks in New York on Pyongyang’s missile programme. The two sides last discussed the issue in June 1997.

Washington wants Pyongyang to halt production, deployment and transfers of the weapons, which have been sold to Iran, Syria and Pakistan, among other countries. The issue took on a new urgency after Aug. 31, when North Korea launched a multistage missile that flew over Japan before crashing, into the Pacific. Although the rocket apparently failed to put a small satellite in orbit, it shook the region by demonstrating that Pyongyang’s capability was becoming more advanced. North Korea has also agreed to resume four-party peace’ negotiations in Geneva on Oct. 21-25 with the United States, South Korea and China. [...]

The United States also announced recently that it would provide famine-plagued North Korea with an extra 300,000 metric tonnes of wheat to feed starving children. The French-based medical charity Médecins Sans Frontières (MSF) said on Wednesday it has pulled out of North Korea in protest against the “discriminatory”’ way in which aid was being distributed and the lack pf monitoring of the process. Foley said the United States was disturbed by reports that the MSF’s access to rural areas had been restricted and called on North Korea “to remedy the access problem immediately.” He said all U.S. food aid went through the UN World Food Programme and monitoring was a prerequisite.

DOCUMENT

”Pyongyang Has to Resolve the Problems With the Channeling of Aid,” AFP (France), Washington, 1 October 1998 (in French).

Extract:

On Wednesday the United States asked North Korea to resolve the problems with the channelling of international aid to the country, as denounced by the organisation Médecins Sans Frontières (MSF), who announced its withdrawal on Tuesday. “We are asking the people responsible in North Korea to resolve the problems of access (to food aid) without delay so that this group can resume its activities,” declared James Foley, a deputy spokesman of the State Department. MSF announced its withdrawal from North Korea last Tuesday, after stating that some North Korean children were being deprived of international aid because they were not part of families considered loyal to the regime. MSF called on donor countries to revise their aid policy for North Korea and impose controls on the use of food aid. Nonetheless, the State Department announced that MSF’s decision would not affect the dispatch of 300,000 tonnes of additional food aid from the United States, emphasising that it would be distributed by the World Food Programme, (WFP), which has control mechanisms in place. This situation is “far from ideal”, remarked Mr Foley, pointing out that the American administration would like to increase its measures of control. He nonetheless added that the United States had observed no “significant diversion” of American aid.

UNICEF and WFP commented that there was no evidence that aid was being diverted and that they would not withdraw from North Korea.

DOCUMENT

“Debate on the Extent of the Famine in North Korea – The United Nations Considers that their Aid Reaches the People it is Meant for,” Valérie Brunschwig, Le Monde (France) Hong Kong, 2 October 1998 (in French).

Extract:

Yet is North Korea suffering from a generalised famine? Despite its outburst, MSF seems to have doubts. “The situation is very different to that in Sudan” explained Eric Goemaere, General Director of MSF, passing through Hong Kong on Wednesday 30th September. “No one’s dying; no bodies are being left by the roadsides. We absolutely cannot confirm that there is a general famine affecting the entire country. We shouldn’t forget that this year North Korea received the largest amount of food aid ever accorded.” Did the MSF teams miss victims hidden away in inaccessible areas? “We didn’t see any trucks collecting bodies during the sixteen months of our presence,” replied Eric Goemaere. “Our only certitude is that the distribution of food and health care is based on political considerations, which condemns anyone outside the system to certain death.”

But these statements were questioned on Wednesday by the UN agencies operating in the country. “We don’t have any proof of diversion of food aid. We’re continuing our operations,” said a spokesman for UNICEF. He confirmed that the children assisted by UNICEF received their food without any political distinctions being made. Whilst “concerned by the questions raised by MSF,” the World Food Programme (WFP), which has access to 210 of the 250 counties of the country and distributes food to nearly a third of the population, also emphasised that it’s aid reached the people it is meant for. “We think that we should stay, in the interest of children and other vulnerable persons,” declared Christiane Berthiaume, spokesman for the WFP.

“We cannot state that there is a generalised famine” MSF

[…] The Venerable Pomnyun, head of a charitable Buddhist organisation present in China, who has questioned some 1,500 refugees, claims that the famine has led to more than 3.5 million deaths since 1994 out of a population of 23 million. For the American Andrew Natsios, of the Institute for Peace, the figure is closer to 2.4 million deaths, with victims concentrated in the poorest agricultural areas. Some electoral information, smuggled secretly out of North Korea, reveals a drop in the population of between 35% and 40% in certain regions. In August, a delegation from the American Senate declared, after a mission of only four days in Pyongyang, that, since 1995, there have been between 300,000 and 800,000 deaths from starvation each year.

As terrifying as all this is, these figures give way to more scepticism than horror amongst humanitarian organisations. The United Nations, which heads the world’s food aid distribution, considers these figures ‘onlly slightly reliable.’ The Red Cross qualifies them as ‘pretty improbable.’ Between the thesis of ‘a genocide masked as a famine’ and the ‘Timisoara syndrome’, the way forward looks tricky for those working ‘in a totally impenetrable regime’ which uses humanitarian aid for political ends. “On one hand Pyongyang uses orphaned children, in a terrible nutritional state, covered with sores and lice, to attract food aid and medicines. On the other, it refuses us access to them on the grounds that this is not a priority population,” relates Eric Goemaere of MSF. MSF has no doubts about these refugee testimonials, “which have their own value,” said one of its representatives, Marine Buissonnière. “But extrapolating them to the entire population leads to overblown conclusions.”

Will MSF be accused of non-assistance to persons in danger? In withdrawing, the organisation is aware that it is nudging the country further towards a return to the medical ice age, where surgical operations take place without antiseptics, anaesthesia or antibiotics, makeshift drips are pieced together with beer bottles and doctors don’t know about aspirin. “The risks are really serious” recognises Eric Goemaere. “But we couldn’t continue working without being able to carry out free evaluations of the needs, without helping the most vulnerable, and without being able to measure the impact of our work.”

On 5 October 1998, the North Korean authorities stated that the MSF statement was inconsistent. On 13 October 1998, the WFP deputy director stated that North Korea was denying aid workers access to many areas where they planned to monitor food distribution. Whilst acknowledging that the situation in North Korea was serious, most of the NGOs and aid agencies kept denying that there was a widespread famine. An official from the Swiss Cooperation Department even stated that the refugees had exaggerated their testimonies because they had to justify why they were on the run. Several NGOs intensified their aid to North Korea, asserting they had always been able to control its distribution.

DOCUMENT

”North Korea Denies the Accusations of Food Aid Diversion,” Le Monde/AFP (France) Tokyo, 7 October 1998 (in French).

Extract:

On Monday 5 October, North Korea rejected the accusations of Médecins Sans Frontières (MSF) regarding the authorities’ diversion of international aid destined for victims of the famine (Le Monde 2 October). According to a senior member of the Aid Committee for Flood Victims, cited by the official agency KCNA, received in Tokyo, MSF’s accusations are “incoherent.” The agency is astonished that a humanitarian organisation can call for a stop to aid for North Korea, claiming the diversion of assistance to the army. “We consider this an act motivated by hostile forces set on sabotaging humanitarian assistance to North Korea,” continued KCNA. The agency added that humanitarian organisations are free to visit the affected regions “unless there are any particular problems” and that aid does reach the people concerned.

“UN Aide Charges North Korea With Blocking Relief Workers,” International Herald Tribune (Reuters), Tokyo, 13 October 1998 (in English).

Extract:

Namanga Ngongi, Deputy Executive Director of the World Food Programme, said North Korea denied UN aid workers access to at least 26 famine-stricken counties for “security reasons.” Mr. Ngongi told a news conference that his agency had asked the North Korean government to allow its aid workers to monitor food distribution in at least 171 of the nation’s 210 counties. North Korea, however, did not say when it would allow relief workers to enter the counties to monitor food shortages triggered by floods in 1995 and 1996 and a drought last year.

DOCUMENT

“Is North Korea Ravaged by Famine?” Frédéric Koller, Le Temps (Switzerland), 26 October 1998 (in French).

Extract:

But today Philippe Biberson denounced the hypocritical silence surrounding North Korea “when everyone agrees about the state of affairs.” A unanimous agreement? It’s not so sure. As diplomatic talks on the future of the Korean peninsula started up again in Geneva last Wednesday, MSF invited all the NGOs still active on the ground to Amsterdam for a private debate, on the same day.

Is there really a famine in Korea? Is it impossible to work there? Give or take a few nuances, the reply from NGOs and programme managers of international aid is unanimous: there is no formal proof of the famine denounced by MSF, even if the situation is considered very difficult and access to North Korean territory is limited. On the other hand, we consider that we have a satisfactory control over our aid, even though we can’t always follow it up 100%. Finally, humanitarian aid can only be linked to a political situation and we don’t have the right to abandon children who haven’t chosen their place of birth.

Thus, there is no question of Swiss humanitarian aid, amounting to some 30 million francs, dropping its programme, and it is even considering extending it by two years. “We cannot talk of a famine,” explained Stefan Kaspar, spokesman for the Direction of Development and Cooperation (DDC). “There are serious malnutrition problems, but the situation has improved in the hospitals we’ve been able to visit.” The DDC, which has an office in Pyongyang since 1994, can access three provinces out of ten, amounting to 20% of the territory. “But when we’re travelling around, we have a good global view of what’s going on” continued the spokesman. “We have control over our aid which is destined for children.”

A famine ‘in slow motion’

As for the testimonies of refugees on the border, the DDC considers them “exaggerated.” “They have to justify why they’ve fled. We cannot imagine that there’s any cannibalism. It’s impossible to hide a famine these days.” The same discourse is held by sources close to this dossier in the UN. The International Federation of the Red Cross is also firmly implanted in North Korea with seven delegates. It provides medical assistance and emergency aid, particularly food aid and blankets. It’s spent 61 million francs in the country since 1995. The Programme Manager in Geneva, Marcel Fortier, also considers that a catastrophe has been avoided by the delivery of international aid. The impenetrable nature of the authorities and the difficulties of working in North Korea still don’t make it such an exceptional case that the organisation has to leave.

Returning from a mission in Pyongyang, the Caritas Manager in Hong Kong, Kathi Zellweger, talked about a famine in “slow motion. I’ve never seen people dying of hunger or children with big bellies like in Africa.” But it looks like the winter will be hard. The harvest this autumn doesn’t look good. Kaithi Zellweger has visited all the provinces in North Korea except for Hamgyong in the north of the country: “We have control over the 6.2 million dollars that we’re offering in aid. It reaches those most in need without any problem. And even if the situation is extremely difficult, it’s important to stay, to show patience. Pyongyang is gradually opening up.”

In the Geneva headquarters of the World Food Programme (WFP), there is nonetheless some caution. A famine? “We can’t confirm or deny it. But we’re sure the country is under threat, we can already talk about pockets of famine,” explained Christiane Berthiaume. Even if things have improved for children under 6, the situation for older people is getting worse. In 1998, the WFP accorded nearly 400 million dollars in food aid. But this could go down next year. “We have good control over our distribution, with 47 people on the ground. But we only have access to 171 counties out of 210. It’s a scandal that there are still regions we can’t get to.” But there’s still no question of leaving. Especially as on 23rd September, Pyongyang finally allowed WFP, associated with UNICEF and the European Union, to carry out a first nutritional survey for which the results should be available at the end of the month. “It’s very dangerous to use humanitarian aid as a way of exerting political pressure,” concluded Christiane Bethiaume regarding MSF’s criticisms.

So that leaves the North Korean regime’s version: MSF withdrew in common agreement with the Korean Democratic Republic’s Committee for the Rehabilitation of Natural Damage. Going softly on MSF, this State agency accuses the western media of “trouble-making” based on acts prepared by antagonistic forces that are trying to thwart international aid being delivered to the Korean people. “We never ask for humanitarian aid from those who don’t want to give it,” concluded the spokesman.

Interview with François Jean

Le Temps: What allows you to state that there’s a famine in North Korea?

FJ: Very little information comes out of the country and the situation remains very obscure. Our conclusion is based on our experience in the field, the opinion of international experts, and finally the testimonies of refugees on the border. We were struck by how these accounts were confirmed by the analysis of researchers.

Le Temps: And on this point, are these testimonies reliable?

FJ: We’ve been to the Sino-Korean border twice. Of course we can’t take all these accounts as gospel and they may not be representative of the entire situation. But we’ve gradually formed an opinion. [...]

Le Temps: How would you describe this famine?

FJ: It’s not a traditional famine. It’s clearly linked to political and economic choices made over the past forty years (particularly the focus on heavy industry). It’s the consequence of the regime’s obsession with self-sufficiency. It’s a very vague phenomenon, which only affects certain parts of the population: those who are considered politically disloyal or who have no utility from an economic point of view. The most fragile victims are obviously the elderly and children. The state has complete control of the food distribution and gives preference to the workers in the strategic sector and the army. The famine hits hardest in the small, disaster-stricken towns.

Le Temps: MSF talks of hypocrisy concerning North Korea. Should everyone follow your example?

FJ: We’re lobbying for humanitarian aid to stop. For us, the most important issue is access to victims and control over the effectiveness of our action, which is impossible in North Korea. During the re-negotiations for our action plan this summer, the North Koreans asked us to finance a programme for rehabilitating their national pharmaceutical industry. That’s not our job. We can’t say that we were expelled, more that we were thanked and dismissed.

Le Temps: If control is impossible, as the UN recognises to an extent, should states put a stop to their aid?

FJ: It’s not for an NGO to get involved in political considerations. However, aid provided by states does send a message: the world is not necessarily hostile. A policy of reform and opening up should be encouraged in Pyongyang, forming part of the gradual transition needed to avoid a real catastrophe. Maybe there’s no alternative, but given that the humanitarian effect of this aid is limited, it would be better to be clear and call it economic aid.

DOCUMENT

“Concern to Spend £1.3m Helping North Korea,” from Conor O’Clery in Beijing, The Irish Times (Ireland), 27 October 1998 (in English).

Extract:

Concern Worldwide is to carry out projects worth $2 million (£1.3 million) next year in the Democratic People’s Republic of Korea, the Irish aid agency’s deputy chief executive, Mr Paddy McGuinness, said in Beijing yesterday. This is more than double the amount committed by Concern in 1998 to the isolated communist country, which has had several years of severe food shortages. “Millions of people remain vulnerable,” said Mr McGuinness, before returning to Ireland after a week spend in North Korea, where Concern operations are conducted by the agency’s full-time representative, Mr Mike McDonagh. “We are in the DPRK for the long term,” he said.

The funding will come mainly from the EU, the US and the Swedish government, and will help pay for schemes such as a food-for-work environmental improvement, experiments with spring wheat and potatoes and greenhouse construction. [...] Concern is one of seven aid agencies, five UN bodies and a number of US organisations working under one umbrella in North Korea. Its target area, the hinterland of the northern city of Pyongsong, has a food deficit of 30,000 tonnes and Concern hopes to make up 12,500 tonnes through introducing spring wheat, a practice not used before in North Korea. The food-for-work scheme will involve distributing wheat, rice, vegetable oil and sugar, supplied mainly by the EU, in return for work in improving damaged agricultural land. Mr McGuinness said he was happy to be able to see with his own eyes that Concern’s efforts in helping North Koreans in practical ways were benefiting those in greatest need.

Recently the French organisation Doctors Without Frontiers left North Korea after 16 months because it said it had not been able to negotiate free access to bring humanitarian assistance to those most in need.

INTERVIEW

This press conference didn’t confirm anything. It just served to air our frustrations a bit after having worked 1.5 years without achieving anything. Our withdrawal would have had a bigger impact if we hadn’t been short-circuited by the French, and if the international communication had been closer to us. We were given lots of promises; everyone said that what we were doing was so brave. ACF took over the northern province when we left. They reached the same conclusions as us two years later. I discussed it with them a bit in Paris, they said: ‘yes, you were right.’ But they stayed, and they had the same problems as us. They thought they could be a bit cleverer, that they wouldn’t have the same experience as we did. They did their exploratory mission; they made promises that were never kept. They were badly perceived by the Koreans who are very proud. In fact, the ECHO representative in the field was an ex-ACF. He had always pushed for ACF to be in North Korea and had kept a budget to one side for them. That’s why the Koreans accepted them, but it wasn’t their choice.

Medicaid, an American NGO, bombarded the country with medicines and medical material. Our negotiating position was very weak. We were sure of being replaced and this turned out to be the case. Yet we’d passed the message loud and clear and everyone agreed to not take over our role or our place. But as soon as we’d gone, the Red Cross took over our place because the money was available. We discussed it a bit with ECHO, everyone was asking us to stay, to have real access. But on this point, I totally agree with the others. We couldn’t stay at any price, pouring millions and millions into a country with no proof of malnutrition. How could we continue giving tonnes and tonnes of food knowing that it was going to feed an army of 2 million soldiers? I’ve no issue with these soldiers eating too, but we should at least have the opportunity of controlling the chain of food aid. I said to WFP people: ‘how do you know where all these tons of rice you’ve given are going?’ Normally there’s ‘food basket’ monitoring at the end of the week! This question really hurt them. ‘No no no, we trust them!’ How could you discuss anything in these conditions? We shouldn’t play at prison guards, but there should be a minimum of surveillance. It’s what we always ask for, in all our MSF programmes, whatever the country, and if we don’t get it, the donors aren’t happy. But none of these rules applied in North Korea.

William Claus, MSF Belgium programme manager, (in French).

INTERVIEW

From what we saw, we always had the impression that there were masses of aid, far more than required for feeding this vulnerable population decently. On the other hand, throughout the three or four years following MSF’s withdrawal, when I was following the dossier from 1998 to the end of 2003, the organisations present in North Korea never stopped reproaching us for speaking out and withdrawing like this, saying that we did them a major disservice. We attended almost all the conferences on North Korea over a five-year period and each time MSF was seen as the big bad wolf. Our speaking out had an impact, it went down badly, particularly with big organisations likes Caritas, who never really digested the drop in funding generated by the criticisms of North Korea’s aid system. These organisations were in a development mode. They were convinced that sooner or later, this approach would have an impact and that they had to continue, even if they didn’t see any immediate results. We embarrassed them by obliging them to explain their calls for funding to their donors.

Our speaking out, despite everything, coincided with the arrival of George W. Bush to the White House and he was totally opposed to the “soft landing” policy of Bill Clinton. Even if the United States has continued to support WFP, they’ve posed a lot of questions on this food aid. This has had a harmful impact on most operators because they’ve had to beef up their justifications for funding.

Sophie Delaunay, Research officer, Foundation MSF France, June to August 1998; Coordinator, MSF France in China, January 1999 to December 2001; co-Coordinator, MSF France in South Korea, January 2002 to October 2003.

On 14 October 1998, the French daily Le Figaro published an article by Philippe Biberson, President of MSF France. He explained that beyond MSF, it was the whole international aid system that was being challenged by the North Korean regime. In the weeks following the press conference, MSF completed the ‘leaving North Korea’ process. MSF organised and participated in several roundtables and symposiums about humanitarian aid in North Korea. François Jean (MSF Foundation) and the MSF France President published in-depth analyses on the role of international aid in maintaining the totalitarian regime in North Korea.

DOCUMENT

“MSF Roundtable N. Korea,” Email from Corien Swaan, Coordinator round-table, previously MSF volunteer in North Korea, to MSF North Korea network, 8 October 1998 (in English).

Extract:

1) Dear all,

To update our supporting sections, the following message. On behalf of MSF France, Belgium and Holland, I would like to inform you that MSF is organising a round-table on North Korea on October 21st in Amsterdam. The round table is one of the events of the ‘MSF leaving N. Korea’ process. Last week we informed the media, this round table is partly meant to inform the other organisations working in N. Korea in ‘private circumstances,’ on our decision. Moreover, the round table is meant to share information and try to come to a diagnosis with the other organisations on what the nutritional and medical needs are in Korea, and how we can respond to them in a responsible way. We will try to come up with a list of common concerns among the involved organisations. There will be no press present at the round table. However, we will try to organize a briefing session in Geneva for journalists and diplomats in the week following the round table. It is also planned to present a report of the Amsterdam round table at the Musgrove conference on humanitarian aid (Georgia, USA) organised Mercy Corps, during 23-24-25 October.

2) Following the update I’ve sent you last week, I got several inquiries from MSF sections on further information on the press release (attached files), and why we are leaving North Korea. Although I am not the official MSF Korea information centre, I will try to provide you with some background information.

To recap the situation: MSF started to work in July 1997 in N. Korea, with Memorandum of Understanding of one year. We worked in 3 provinces to distribute drugs and raw materials, and to set up therapeutic feeding centres in the county hospitals. After an assessment in North Hamgyong, this province was added from February 1998. Our aim was to start the project to ‘be on the ground’ and learn then more about the nutritional problem arid medical needs the country is facing. During our work (myself I worked as medical doctor in N. Hwangae), we did not met many admitted malnourished children in the nutritional centre, and also we did not get enough access into the medical data, files, wards, etc., to get a better view on what is going on (the official report of the mission is attached as well). So therefore we still were not able to deny or confirm a famine in DPRK (and the only indirect source is the interviews of Francois Jean, see attached file). Not being very satisfied with the current programme, we started drafting a new project proposal, based on working in a smaller area with closer cooperation with the medical institutions (and with better conditions on access and evaluation, but that was not even brought up yet).

A very preliminary draft was presented by William Claus (MSF B, being backup section until September) for the N. Korean authorities at the beginning of August. Without even going into detail of any further plans of our side, they just asked for raw materials, for drugs, and assistance with rebuilding their drug industry. This request was not new; Marie Rose our Head of Mission already explained them several times that MSF is not an organisation providing this. So the negotiations were stuck before they even started. This meant that our MoU expired in the first week of September (we got 2 extra months to finalise the implementation of the original project), so the visas of expats expired and we had to leave (so not really kicked out, but we also could not stay, although we would have wanted to stay). We still would like to give humanitarian aid to N. Korea (of course under certain conditions), and left with the message that they can reopen negotiations if the want.

The goal of the press release was to tell the outside world why we were leaving. So this was not because of the rerouting of food/materials (we don’t have any proof of that). I personally regret that quite some journalists have interpreted the press release like that. Also, our message was not that there is a famine going on in N. Korea. As expats we have no proof of that from observations from the field. We only have the interviews of Jean Francois, which are very worrying of course. The only thing we have proof of is that there are vulnerable groups among children, which fall through one way of the other, outside the food distribution and/or medical system, and that the Korean government absolutely did not cooperate with us to help those special children.

We left N. Korea, but we did not close the book. From outside, we try to keep the discussion going on how what the medical and nutritional needs are in N. Korea, and how humanitarian aid can be given in a responsible way.

DOCUMENT

“MSF Report on Humanitarian Aid Policy Towards North Korea,” Memo [no name, no date], probably from Corien Swan, probably November 1998 (in English).

Extract:

Reports of meetings organised by WFP, MSF, and Mercy Corps. WFP/NGO meeting on North Korea (Rome, 10/9/98):

Present were WFP, OCHA, MDM, ACF, CRS, Caritas, DFRC, German Agro Action. Critical remarks were made towards WFP, what the value of the newest nutritional survey would be, how representative its results are, and how it can be that such an influential organisation still cannot deny, nor confirm a famine.

The main points which emerged were:

- The need for a strategic approach and collective thinking.

- Minimum criteria and standards of engagement should be established

- Information about access, monitoring conditions, and MoUs should be shared

- Common assessment by the humanitarian team, such as that conducted after the floods, should continue under the humanitarian co-ordination mechanism

- International staff needs to be able to move more freely, with fewer restrictions

- Most organisations now working in DPRK are considering a move from vulnerable group feeding to agricultural rehabilitation.

It also was felt that the humanitarian aid has left the emergency phase and that mid- to long-term projects had to be proposed. There are difficulties to plan those projects with only little information, and donors are reluctant to sponsor for the same reason. OCHA announced it will facilitate the development of a common humanitarian action plan for the 1999 consolidated appeal.

MSF Roundtable on ‘Experiences and Prospects of Humanitarian Relief in North Korea,’ Amsterdam, 21/10/98.

Present were UN organizations, NGO organizations (European and American), governmental donors and ‘Korea experts’. From the discussions, the following conclusions could be made:

Needs: Although we don’t have exact data, the expectation is that the situation is worse than we are allowed to see (e.g. as in the forbidden counties, information such as that from the food refugees).

Food: there will be a continuing food shortage, because of agricultural incapacity, insufficient redistribution and economic collapse resulting in lack of funding. The extent is not known, but the expectation is a continuing malnutrition at least of the vulnerable groups.

Health: the health care system has collapsed and the population is weakened, leading to re-emerging diseases and unnecessary mortality. [...]

Mercy Corps ‘Musgrove III: Humanitarian Aid to North Korea’ (Musgrove, Georgia, USA)

Participants were American NGOs working in North Korea (among them CARE, CRS, World Vision and Mercy Corps), representatives of the US government (Congress, House International Relations Committee, US Dept. of Agriculture, USAID and US Dept. of State), WFP, UNDP, American Red Cross, epidemiological consultants from John Hopkins Institute and CDC Atlanta, and MSF.

The discussions led to the following agreements: Overall goals: to address immediate needs and to reconsolidate relations NK/USA.

- Interaction will contact OCHA about principles in humanitarian aid then the American organisation will look further into them.

- PVO will try to get a liaison monitoring office in Pyongyang, serves as ‘clearing house’.

[...] Overall impression: the American participants were very optimistic on the changes in North Korea, and their possibilities to intervene. Their aid/interest is more based on long-term aid relations with North Korea; all small improvements are already satisfying. The PVO will try to get some better conditions in their MOU. [...] More attention to structural, long-term, agricultural aid; the direct humanitarian relief aid has less attention. Although they regret the EU Delegation came to the conclusion that the emergency is over in North Korea, ‘Europe needs to be re-informed again.’

3. Conclusions

On the humanitarian situation: there are clear medical and nutritional needs, but difficult to define to which extent, information from the field and border-assessment is not enough information. There still are acute needs, while long-term aid should start simultaneously. The North Korean authorities seem to have shifted the priority from acute medical aid towards long-term rehabilitation of their medical supply (drugs factories). The attitude towards direct food aid has not changed, and they also allow more long-term, mostly agricultural development aid in. Vulnerable groups are difficult to identify, they are different from the groups we normally consider as the one’s in need. Among them are probably the ‘non-producers’. It is necessary to get better understanding of the system. Also, the homeless and the non-institutionalised have less access to care. The constraints MSF faced while working in Norm Korea in terms of assessment of needs and vulnerable groups, and working according to humanitarian principles were the main problems other relief organisations are dealing with as well. Most organisations therefore feel the need to come to a common approach towards the North Korean authorities, in order to have a set baseline of humanitarian principles. In this way, some of the constraints could be overcome.

Some independent organisations would like the proposed OCHA principles to be more concrete, other organisations (e.g. IFRC) have started already long-term interventions, and therefore they are less flexible to commit themselves. American NGOs in general are more positive towards the developments in working in North Korea, and for them to get field representatives in is still a high priority. Also, since the American NGOs are more on one line already, the need for common principles is less.

DOCUMENT

“Humanitarian Aid Frozen,” Philippe Biberson, President of MSF France, Le Figaro (France) 14 October 1998 (in French).

Extract:

The announcement on 30 September that Médecins Sans Frontières was pulling out of North Korea reopened the debate on the extent of the famine and the use of aid in that isolated country. It also raised questions about the reasons for such a decision, at a time when hundreds of thousands of Koreans were enduring famine. However, there was nothing voluntary about MSF’s decision to leave: it was forced upon them by the North Korean authorities after they refused to fund a programme to revive the country’s pharmaceutical industry.

At a more fundamental level, this forced departure illustrates the difficulties and ambiguities, perhaps the impossibility, of humanitarian action in North Korea. For three years, Médecins Sans Frontières and the few humanitarian organisations authorised to work in North Korea were closely monitored and forced to distribute aid clandestinely. Despite their best efforts, they never succeeded in guaranteeing observance of two key principles of humanitarian action: the ability to evaluate needs independently and to monitor food distribution in order to be certain that it is reaching the starving. And it was precisely because of its insistence on applying these principles that Médecins Sans Frontières was forced to leave North Korea. This ‘quiet’ expulsion (following that of Médecins du Monde two months ago, for the same reasons) has, however, provoked no reaction on the part of donor countries.

Were it not for the tragic situation with which a section of the population of North Korea is contending, this question of principle might appear to be theoretical. But the requirement for an independent needs assessment, and the imperative to monitor the distribution of aid are more important than ever, in the light of what is gradually emerging about conditions in the country.

State of famine

Despite the regime’s efforts to maintain a news blackout, the experience of humanitarian bodies, the work of academic researchers and above all, testimonies by refugees who have reached China, enable us to lift a corner of the veil concealing the strategy being adopted in North Korea. Reports by refugees, always valuable in murky situations, as in the case of Cambodia under the Khmer Rouge in the late 1970s, testify to a terrible lack of food that is causing the death of hundreds of thousands of people, and to hunger, exhaustion and disease.

One may suspect that the causes of this famine are more political than climatic. It is a consequence of catastrophic economic policies, and reflects the inability of the North Korean economy to generate the foreign currency required to meet people’s need for cereals. Or rather, it reflects a clear determination to put the regime’s priorities before the survival of a section of the population because this human tragedy is the result of conscious political decisions.

Political criteria

Under this impoverished economy, in which rationing is a means of social control for fifty years, resources have been allocated to the population by the state according to criteria based on political loyalty and economic usefulness. International aid is not exempt from this rule, but is channelled through the official distribution system and allocated first to party functionaries, members of the armed forces, and workers employed in strategically important factories. At the same time, groups seen as hostile, because of their family backgrounds, the inhabitants of devastated cities, or workers in factories unlikely to help revive the economy, are excluded from the distribution system and left to face starvation unsupported.

Everything suggests that vulnerable populations, who are precisely those for whom international aid is intended, are being left to their own devices. Humanitarian aid is managed by the regime according to political considerations, without regard for people’s needs. Rather than accommodating to these policies, in the name of short-term realism, donor countries would do better to support humanitarian organisations in their efforts to obtain genuine access to the victims. In North Korea, there is total conflict between humanitarian efforts and the regime’s thinking. This is why international aid, which is supposed to be a gesture aimed at opening up, is today hitting a brick wall.

DOCUMENT

“North Korea: A Famine Regime,” François Jean, Director of Research, MSF France Foundation, Esprit (France) February 1999 (in French).10

Extract:

In the spring of 1995, several months after the end of a crisis triggered when Pyongyang threatened to withdraw from the nuclear non-proliferation treaty, North Korea was back in the headlines with a request for food aid. A disbelieving world thus learned that this tightly sealed nation, on the brink of possessing a nuclear weapon and long-range missiles, was also a nation drained dry, incapable of feeding its people and dependant on international aid for survival. North Korea has been on international life support for four years now. The food emergency, first characterised by officials as the result of flooding in 1995-96, then of drought in 1997, set in motion one of the largest food aid programs financed by the international community in the past decade.

For the past four years, the rare humanitarian organizations authorised to travel in North Korea have speculated on the dimensions of the crisis. Some speak of an acute food shortage; others depict a situation of famine that, according to estimates, would have caused anywhere from several hundreds of thousands to more than three million deaths over recent years. The degree of uncertainty is a clear consequence of the nation’s impenetrable facade. The North Korean regime has now lifted a corner of the veil, of course, in its request for international aid, but it continues to conceal the gravity of the situation. In this country, isolated from the world and wrapped in a siege mentality, all economic and social data—even hospital patient registers—are considered state secrets. Moreover, the few humanitarian organisations present in the country are subject to strict monitoring and unable to freely evaluate the situation. They may on occasion see cases of acute malnutrition, but they can only observe what the regime itself allows to be seen. Beneath such difficulties of assessment, however, speculations about the dimensions of the crisis reveal a deeper flaw in our perception of the process of famine in North Korea. […]

A Policy of Engagement

North Korea has been dependant on international aid for four years now. The regime has adapted itself quite well; after years of poor-quality grains it is once again importing rice, and in large volumes. Foreign food trade is still in balance and, now that free imports have taken the place of imports at concessionary prices, the regime can still brandish the banner of food self-reliance. […] Likewise, through nuclear blackmail, Pyongyang was able to obtain two light-water reactor stations in October 1994 and, as they awaited activation, 500,000 tonnes of oil per year would be conveniently balance the loss of Soviet imports. Again, acknowledging its ‘agricultural troubles’ permitted North Korea to receive sizeable amounts of aid to replace - or rather to augment, since Beijing had resumed its program in the meantime - Chinese exports on preferential trading terms. Unprecedented though this avowal of failure may have been, it is no radical departure from past form. It is consistent with the longstanding practices of a regime gone beyond master in the tactics of unpredictability. From nuclear threats to floods, from missile experimentation to famine, North Korea has continually exploited its nuisance capacity - be it as threat or as vulnerable victim, on the verge of exploding or imploding - to wring the resources it needs to survive from its friends, and now its enemies.

For their part, the countries concerned have readily responded to this request for aid, showering ever-increasing quantities of food aid on Pyongyang over the last four years. The chief impulse for this involvement is fear of a North Korean implosion. For, while each of these nations looks forward to the imminent end of this totalitarian system, they dread a sudden collapse. All analyses are shaped by fears of instability and the spread of refugees, of political uncertainty and its strategic implications, and of the economic consequences of reunification. This is particularly so in South Korea, where the costs of German reunification were studied with added concern because the demographic comparisons and economic gaps are more unfavourable by far in the Korean case. Seoul, Beijing, Washington, and Tokyo dread the scenario of an abrupt North Korean collapse, leading to an ‘emergency reunification’. For different reasons, therefore, each of these countries has pursued a policy of ‘constructive engagement’ aimed at preserving stability on the peninsula and nurturing developments likely to facilitate a soft reunification of the two Koreas. Ex-South Korean president Kim Young Sam, comparing North Korea to an airplane rapidly losing altitude, has said the goal is to avert a crash and encourage a soft landing. […]

Betting on a soft-landing assumes that, confronted with this economic impasse, it would be in the interest of North Korean leaders to implement the reforms needed to get the economy started again. And that, in the short-term, it would be in the regime’s interest to feed the neediest in order to avoid population displacements and expressions of discontent - even revolt. In sum, the countries involved are proceeding on the theory that their notion of avoiding a crisis through a gradual opening up of society is consistent with the North Korean regime’s priorities, if only because of a mutual concern over stability. The second assumption underpinning this policy of engagement is that international aid might encourage a dialogue over exactly the kind of political reforms the international community would be able to support during a transitional phase of the kind that would ease the system’s gradual evolution.

For the North Korean regime, as well, the current situation is deeply ambiguous. For, while it has once again demonstrated its unrivalled capacity for obtaining the means of its survival from abroad, the cut-off of aid from Eastern-bloc countries did cause the leadership to turn to the “imperialist” nations. This fork-in-the-road in its tradition of extortion poses a genuine challenge to a reclusive regime that keeps its people in complete isolation and draws legitimacy from how it deals with the hostile, squalid world outside. Any prospects for reform should be assessed in that light. Though it is quite likely that some North Korean leaders are at least conceptually aware of what reforms are needed to escape their predicament, they do not appear ready to run the political risks involved. Just as Seoul attentively followed the German reunification process, Pyongyang, too, watched - first in perplexity, then in horror - as the reform process in the Eastern-bloc countries led to the break-up of the Soviet Union and the events in Tiananmen Square. The lessons they derived were all the more pointed given the very narrow margin for error in this divided country; any loss of control would lead not only to the fall of the regime but the disappearance of North Korea via absorption. In such a context, a posture of isolation and defiance towards the outside world is viewed as a key factor in the system’s survival. The regime’s primacy rests on ideology, and there is no reason to believe it will commit to reforms that might weaken its control over society. […]

“Humanitarian Aid”

International aid to North Korea has chiefly taken the form of emergency humanitarian relief, for two reasons: first, because it came in response to a request from North Korean authorities formulated in those terms. Officially, international assistance was meant to alleviate the consequences of the 1995-6 flooding and, later, the 1997 drought. And allusions to the natural disasters in North Korea have indeed become somewhat of a regular feature in United Nations reports. Bureaucrats at the international organisation are doubtless not fooled by this rhetoric of climate, essentially generated by diplomatic considerations. Nonetheless, one cannot avoid being struck by the remarkable parallels between regime propaganda and the stilted language of the UN - there is the sense, at times, that certain officials have been convinced by their own rhetoric. The second reason is that the humanitarian label enables donor countries to sweep aside any domestic reluctance to support the North Korean regime. In Washington, particularly, the Reagan doctrine that ‘a starving child knows no politics,’, declared during the 1984-5 Ethiopian famine, made it possible to secure the support of a Congress hostile to any form of aid to this communist country, still technically at war with the United States. In South Korea as well, humanitarian concerns cleared the path - after much hesitation - for aid to the other Korea, before the election of Kim Dae Jung and the introduction of a policy of engagement - the ‘sunshine policy’ - provided a more favourable context for initiatives towards the North.

Humanitarian aid has thus become a key element in diplomatic manoeuvrings between North Korea and the “international community,” particularly in the context of multilateral talks between Pyongyang, Seoul, Washington, and Beijing to reduce tensions in the peninsula and work towards the possible signing of a peace treaty, forty-five years after the truce accord of Panmunjom. Though it denies it, the United States uses humanitarian aid as a carrot and stick to bring North Korea to the negotiating table and make concessions, as demonstrated yet again by the release in October of 1998 of 300,00 tonnes of food aid just prior to the renewal of talks. Pyongyang, on the other hand, tries to raise the ante by making the delivery of ever-increasing quantities of food, or more recently grain, a pre-condition for joining the negotiations.

Though international aid is first and foremost a policy instrument, humanitarian concerns are not, for that reason, entirely absent. All the participants hope aid will ease the plight of the neediest groups. Faced with a closed nation in a state of paranoid relations with the outside world, donor countries have encouraged United Nations agencies and NGO’s to intervene so as to ensure that aid to the ‘flood victims’ truly reaches those for whom it is intended, and is not used by the regime as an instrument of power, or to feed the army. Furthermore, donor countries are hoping that an enhanced international presence, together with more and more mutual contact on the ground, will foster a climate of confidence and inspire a growing openness in the country. Pyongyang, on the other hand, sees these same humanitarian organisations as a collective Trojan horse, fearing they will have a ‘spiritually polluting’ effect, or weaken its control over society. While the regime has been obliged to accept the presence of a dozen humanitarian organisations in order to obtain aid, it goes to great lengths to limit their freedom of action.

North Korea is a dramatic example of aid under murky conditions; the few humanitarian organisations authorised to work in the country are unable to determine the extent of the famine and are therefore reduced to blindly distributing aid. Despite every effort, the organizations present in the country since 1996 have never been able to implement two core principles of humanitarian action: the ability to assess needs with complete independence, and the ability to freely monitor the distribution of aid. As a result they cannot guarantee humanitarian aid is truly reaching starving groups. They have been reduced to managing what is, in effect, economic aid to North Korea. The issue of needs assessment and monitoring distribution is indeed of central concern to the international community, but there is still little pressure exerted, perhaps because donor countries view humanitarian aid merely as an instrument to further the policy of engagement. Pyongyang understands this full well; it reacts virulently against even the mildest attempts to monitor food distribution. In January 1996 the Ministry of Foreign Affairs stated: “If biased interests continue to impede relief to North Korea by politicizing humanitarian issues, we will do without international aid.”

Concealed Famine

This attitude is a key factor in North Korea’s famine. It arose out of a breakneck pursuit of total self-reliance. Likewise, it was the refusal to allow access of any kind that allowed it to spread. There is no doubt that with better access to information and a quicker response, North Korea could have averted the famine. No matter where it hits, famine cannot spread without the aid of indifference or deliberate concealment. In North Korea, as previously in the USSR or China, no one can say exactly to what extent the manipulation of information kept residents of the capitol and its ruling elites in the dark as to the magnitude of the problem. Word of the famine doubtless now circulates in North Korea, along with that of China’s comparative affluence—a new and crucial development in this mobilized society, isolated from the world. But, if cadres do understand the seriousness of the situation, they will not speak frankly about it; they are creatures of the system’s success.

And international organisations, acting in response to the narrative of natural disaster, observe cases of acute malnutrition but are unable to identify which groups are threatened. A few manage, nevertheless, to experience some portion of the reality first hand, but dare not speak out for fear of losing access to the country. A virtual smokescreen is thus created, enveloping the identities of the starving and thwarting efforts to provide relief. Information is useless unless it circulates—it congeals in bureaucratic jargon. In the course of its own famine, China revealed the devastation propaganda could produce; it took three years - and thirty million dead - for the fog of language to finally clear. The crisis never would have attained such magnitude if leaders hadn’t been so deeply ensnared in their own illusions. Nor would the famine ever have attained such intensity if realistic data had existed to offset the official rhetoric.

Information circulates more freely in North Korea than it did in the China of the Great Leap Forward, however. Though the regime stubbornly endeavours to conceal the seriousness of the situation, some problems were acknowledged at length and international aid actively solicited, with clear success. Since 1995 Pyongyang has been the recipient of ever-increasing quantities of food aid - more than a billion dollars worth over four years - and the latest appeal from the United Nations for a sum of $376 million dollars represents the second-largest international program of relief aid - after Yugoslavia - launched in 1999. At present, food aid and concessionary trade terms appear sufficient to bridge the food shortage. Trade with China and South Korea essentially serves as a supplement to international assistance. But the history of modern famines shows that famine can come about under stable conditions, even where there is a food surplus, as was the case in Bengal in 1943 and even in certain provinces of China during the Great Leap Forward. In other words, the defining feature of famine is not necessarily a shortage of food - though that may be one explanation - rather, it is the fact that some categories of the population have no access to food. The central issue in a famine situation, then, is how resources are distributed to the neediest groups.

Governing authorities in democratic countries pin their credibility on their ability to implement redistributive policies and assist population groups threatened by crisis on a large scale. When information circulates freely - moreover when it is a basic component of a pluralist political system, not only does government have data on which it can act but this very data can force it to act, via pressure from the media, opposition parties, and public response. As Amartya Sen points out: “it is hard to cite an instance of famine occurring in a country with a free press and an active opposition as part of a democratic system.” Nothing of the sort exists in North Korea, whose leaders seem unready to sacrifice the regime’s priorities to protect a portion of the population. The problem in North Korea today is not so much the availability of resources as it is one of distribution. With international aid, it appears North Korea now possesses the means to avert famine. If it does not do so, it is out of a conscious political choice to abandon a portion of the population to its fate, rather than have it exposed to foreign view and contact.

Scarcity and Rationing

When international aid arrives in North Korea it is turned over to the authorities; then channelled through the Public Distribution System (PDS). The lack of any real opportunity over the past four years to evaluate the situation and monitor distribution has fuelled questions and debate over North Korea’s use of aid. The PDS’ effectiveness is not at issue. For forty years it has supervised the flow of food and supplies to the country’s entire population. Neither is the diversion of aid, so often noted in the army’s case, the problem. Food continues to be distributed - as it always has been - according to the regime’s priorities. What is really at issue is the assumption that the regime places priority on feeding ‘vulnerable’ population groups. Like questions about the scale of the famine, debates over the regime’s use of aid demonstrate a profound misunderstanding of how the North Korean system operates.

Rationing is both a standard operating procedure and a means of social control in North Korea. In this closely supervised, perpetually mobilised society, the state provides for all of society’s needs. Wages and taxes play only a marginal role, and the population is wholly dependant on a planned, centralized system of resource allocation. Each individual is dependent on his or her work unit for access to housing, clothing, education, health, cultural life, etc. Similarly, the entire population (except for peasant members of cooperatives) is dependant on the state for the distribution of grain, according to a complex scale that factors in social status, job, age, etc. North Korean society is probably one of the most hierarchical in the world. As a police state it is certainly one of the most formidable, as well; its citizens are the objects of constant surveillance. Continually updated individual files determine each person’s social status and position. […] Society is thus organised in concentric circles around the Great Leader’s family, with the families of counter-revolutionaries consigned to purgatory.

At the Fifth Workers’ Party Conference in 1970, Kim Il-Sung introduced a system of classification that organized society into three classes - a core class, a suspect ‘wavering’ class, and a hostile class, etc. with a total of fifty-one categories. Since that time, the system has been modified during periodic phases of reclassification, but every individual’s status is still determined by political loyalty and family history. This complex hierarchy governs every aspect of social life. Obviously it determines opportunities to rise to senior positions in the party and the army - but it also affects access to material goods. Class membership leads not only to privileged access to education and promotions to positions of responsibility, but also to the perks and privileges these entail: cars, special stores, heated apartments, health care, etc.

Food distribution involves enormous disparities, as well, and is closely regulated. Other criteria enter in besides class, such as age or type of work. These determine grain (or, in the past, fish or meat) allowances to the very gram. In the 1970’s daily ration levels ranged from 800 grams of rice - for workers in heavy industry, military aviation, or senior party officials - to 200 grams of a mix of poor-quality grains for those trapped in groups classified as hostile and condemned to waste away. Here again, conditions altered after a series of ‘patriotic withholdings’ deducted from rations in the 1970’s and 1980’s, and later with drastic cuts ordered under the ‘hard march’ of recent years. With no grain to distribute, the PDS’s role began to diminish in the early 1990’s. Later, rations were reduced even in Pyongyang and the army. Then, in the mid-1990’s, the PDS ceased to function completely in certain regions and for certain population categories. Some groups were dropped from the system, particularly those who were tainted socially, or worked for idle factories, or lived in remote regions—more often than not these things coincide. In the climate of acute scarcity that emerged during the 1990’s, this unegalitarian system of resource allocation had tragic consequences for some population categories.

Famine and the System

As circumstances worsened in the mid-1990s the rationing system hit bottom. Faced with shortages of such magnitude, the regime tacitly abandoned all effort to feed the entire population. With the centralised system of resource allocation unable to carry out its functions, its responsibilities devolved to the provincial and local levels. This de facto decentralization had a particularly sharp impact on certain regions, which appear to have been cut off from distribution channels and left to their fate. The accounts of refugees who managed to reach China reveal that, for example, the distribution of supplies was suspended from 1994 on in the provinces of Hamgyong, Yanggang, and Chagan. Because most of the refugees were natives of these border areas we have little data on other regions, but it would be no great surprise if these remote, sparsely inhabited provinces were among the hardest hit. There are several reasons for this: inadequate transportation and lack of fuel for supplying these provinces, which are distant from the capitol and the agricultural regions of the southwest of the country; or too few influential apparatchiks to secure distribution; or too many persons of no importance, in these traditional regions of exile. Most important: the absence of any economic advantage - idle factories and closed mines, subsistence agriculture - in these mountainous regions in the northern latitudes […].

Nevertheless, the famine is not circumscribed geographically. First, because in a country where individuals are assigned to work units, where all displacement is monitored, and where only the privileged are authorised to live in Pyongyang, geographic location often merely mirrors and coincides with political classification. Second, and most importantly, because even in neglected regions, favoured categories of citizens have continued to receive some small amount of food. The food shortage may have virtually drained the system of distribution dry, but it has not caused it to disappear entirely. The regime adapted itself to scarcity without allowing its priorities to be undermined - if anything they were reaffirmed. Rather than undermine the dogma of food self-reliance by importing food or trying to establish a safety net for the most vulnerable, the regime concentrated its meagre resources on groups that were the most instrumental to the system’s survival and the functioning of the economy. Paradoxically, the flow of international aid through these official channels revitalized them to some degree, and may have reinforced this discriminatory approach. Perhaps there was no other choice, in a country where every aspect of social life is controlled by the regime. In North Korea, famine is deeply woven into the fabric of privilege the regime has constructed. It is a social, not a geographic, fact. […]

Starving

This population group, which was dependant on the State for three generations and is now left to fend for itself has had to improvise in order to survive; in just a few years bartering and trading have become widespread. Peasant markets, previously authorised to operate three times a month, are now held daily in cities and at roadsides, selling grains at prohibitive prices, plants and shellfish gathered here and there, furniture, and anything else people are driven by poverty to sell. There are also products from China - medicines or clothing brought over the border. This small-scale trade, just barely tolerated by the authorities, has become the main alternative for those who have been cut off. But in the end many cannot get by on these transactions - a kind of shabby echo of the caloric trade-offs the regime practices in its trade abroad, which will just barely provide them a bit of cornstarch for their soup. Some die in silence from hunger, illness, and exhaustion. Others, often survivors of shattered families, turn to migration as a last resort. In a society where leaving one’s family and work unit means losing every kind of support and social standing, very few take to the road.

In a country where neither work nor ration allowances are available outside of the official system, no one knows where to go. In a system where every displacement is closely monitored, this mobility seems nevertheless to be tolerated. Perhaps it is because these migrants and, often, these abandoned children, have become phantoms. The regime simply averts its gaze; these displaced persons, beyond reach of international aid, have vanished from society - they do not exist in the North Korean system. Some make it to China, where they stay a few days or a few months. They try to find food, medicine, assistance, or work, and then usually return to help to their families. These refugees or migrants who have been able to reach China are the only North Koreans with whom it is possible to speak freely.25 They are doubtless not typical of the country’s population as a whole: first, because they often come from the border regions; second, because they have left their families and work units, a step very few can bring themselves to take. But they do accurately reflect the fate of persons cut off from support, those vulnerable population groups humanitarian organizations speak of and for whom international aid is, in theory intended. There are perhaps - no one knows - five to six million people cut off from support in North Korea, a quarter of the country’s population. In recent years, they have died by the hundreds of thousands. If nothing changes, they will continue to die by the hundreds of thousands in the years to come.

INTERVIEW

And then, there was the round table. That was the idea: ‘OK, we are leaving, but it doesn’t mean that we close the doors,’ that’s what we said. So we thought: ‘what can we do?’ And the idea was born that all the organisations that worked in North Korea would come together in Europe, and that we would step back from it and think: ‘what’s going on? What position do we take?’ And what came out of it is that all the organisations had the same constraints and that if we had the same policy to say: ‘we only want to stay under this and this conditions. then we could make a better position towards the FDRC.’

We wanted to have some feedback, a better understanding: ‘what’s going on? What problems do we face and how do we approach them?’ Basically, it was a bit like facilitating the future for other organisations and also for ourselves, how to learn from it. I remember that the other agencies found it weird that we had to do such a big press release and they were not happy with that because it didn’t have an added value for WFP, or UNICEF. But from what I recall we were very angry, the NGOs were very critical towards the WFP because they just gave a lot and didn’t ask anything in return. Well of course, we wouldn’t mind, we wouldn’t be unhappy if journalists went to the WFP and asked: ‘why do you stay? How do you guarantee your food is not ending up with the military?”

Dr. Corien Swann, physician, MSF Programme in DPRK, January to September 1998 (in English).

INTERVIEW

To me, our withdrawal is entirely explicable, especially when one begins to define the concepts of humanitarian space and direct contact with patients. Where I believe we were rather weak was after the withdrawal. In the end, there was only one person who had a coherent position and that was François Jean, in the research he carried out after the withdrawal. François came here to meet groups of academics, those attending the conference, in order to try to understand what was really happening in Korea. What is the nature of the regime? How does aid fit in with the political and economic crisis, and so on. Unfortunately, he was the only one doing that work at the time.

In February 1999 he published ‘North Korea, a Famine Regime.’ We translated it and it was soon posted on our website. François attended a conference in Florida with the Mercy Corps and other American NGOs, who were the most belligerent advocates of returning to Korea. He continued to approach these groups at regular intervals. At MSF USA we were not yet at that point. I confess that we hadn’t made best use of all the discussions in order truly to understand where we could have got in step with them and genuinely put resources at the service of that research. I found a Korean PhD student at Columbia University. François had met him and had said: ‘he may be good, he’s prepared to give us a few hours’ work.’ But it wasn’t easy, because he didn’t quite understand MSF was doing.

In September, October, November and December 1998, I continued to be active in this NGO working group on North Korea. Once a month, there were meetings to which representatives of WFP and similar organisations were invited. But in time I began to run out of steam, because I realised that since we were no longer in North Korea, MSF had nothing more to say. That was our last word on the subject.

Antoine Gérard, Head of Programmes Department, MSF USA, (in French).

EPILOGUE AS OF 1999 …

Throughout the end of 1998 and early 1999, the MSF France team in China continued to develop all possible contacts, explore opportunities to assist North Korean populations in flight to China from their North Korean counties, and in North Korea through cross border activities.

In April 1999, two members of the MSF team in China entered North Korea under the cover of a Chinese company on a ‘business trip’ from Beijing to Hamhung province. During their visit they managed to distribute some food aid to orphanages.

From 3 to 6 May 1999, NGOs bringing assistance to North Korea met in Beijing. Several South Korean NGOs publicly asked MSF to resume its activities in North Korea.

DOCUMENT

“South Korean NGOs Call on MSF to Resume its Aid to the North,” Le Monde (France) Beijing, 7 May 1999 (in French).

Extract:

From 3 to 6 May, the twenty-three South Korean non-governmental organisations taking part in a seminar on humanitarian assistance to North Korea, held in Beijing, called on Médecins Sans Frontières to resume its aid activities to the people of North Korea who were suffering famine. In a text published at the close of the seminar, South Korean NGOs maintained that MSF’s decision, in 1998, to suspend its activities due to the lack of transparency in connection with the distribution of its assistance, led to its “turning its back on the possibility of saving more human lives”, and of discouraging international interest in the tragedy of North Korea. The signatories acknowledged having, in the past, taken decisions similar to MSF’s, because of the risk that their aid would be diverted for the benefit of the North Korean army. “This inaction, in fact, allowed millions of people to go on dying.” In conclusion, they urged MSF to “understand” the need to pursue “with greater patience” its work in aid to the victims of the North Korean regime.

DOCUMENT

“NGOs Argue Over Aid to North Korea”, Philippe Pons, Le Monde (France), 9 May 1999 (in French).

Extract:

These vagrant children illustrate the great dilemma of humanitarian aid to the DPRK: access to the most vulnerable sections of the population. This lack of accessibility led to the withdrawal of Médecins Sans Frontières (MSF) in September 1998; a widely publicised withdrawal that changed nothing. Hence, the appeal to MSF by South Korean NGOs to reconsider its decision (Le Monde, 7 May), which gave comfort to sectors of opinion opposed to such aid, especially in South Korea. “The North Korean regime is what it is. We need to know that, and to demonstrate, in respect of humanitarian aid, the same spirit as the Red Cross: caring even for the enemy. It is the [North Korean] population and not the regime, that is suffering the consequences of our changes of mood,” said Moon Kyu-kang of the Korean Sharing Movement, a Buddhist organisation especially active on the China-North Korea border.

DOCUMENT

Report to the Annual General Assembly, Philippe Biberson, President of MSF France, 28 May 1999 (in French).

Extract:

North Korea: this mission was the subject of a long paragraph in the previous Secretary’s report. This year, it is the (provisional) epilogue that we have to write. Not very surprisingly, the negotiations that we held with the North Korean authorities were inconclusive. Or more strictly speaking, they led us up a blind alley: on one side, there was the blank imperviousness of a regime that refused to listen, on the other side of the street, our principles and “inadmissible” proposals, and at the far end, the resigned wall of silence of the ‘international humanitarian community.‘ Médecins Sans Frontières left the country in October, explaining that to distribute aid “in the dark” would offer no guarantee that it was benefiting those dying of hunger. On the contrary, there was a risk that this massive aid (not only that provided by Médecins Sans Frontières) would serve to maintain the “starvation machine.” There followed protests, and silence.

In North Korea, people continued to die of hunger, disease, cold and destitution. Some people said the situation had become even worse, and continued to call for more aid. At a recent conference in Beijing, aid organisations involved in North Korea called on Médecins Sans Frontières to return to the capital, Pyongyang. I shall not say too much more, because this is the subject of this afternoon’s debate, but it appears that in North Korea, the more aid provided – and the amount seems derisory – the less we hear about it, or only sporadically, when “personal stories” emerge.

I must also say that this withdrawal from North Korea left us feeling very uneasy. Did we withdraw or were we expelled? Those who condemned MSF’s “highly public” withdrawal were mistaken. It was not improper to organise a press conference to report our doubts about the use of many million of dollars in public aid. What would have been improper would have been to say nothing. Médecins Sans Frontières was one of the few organisations to seriously and publicly question the regime on the use of aid. But we no longer doubted the reality of the famine; we sought every possible means of gaining access to the victims. Last April, Marcel, Marine and Sophie mounted an “expedition” from Beijing, under the pretext of a business trip, travelling with Chinese businessmen to the North Korean province of Hamgyong. Is there a more “independent” route, or a more reliable way of reaching local people? That‘s the question we are trying to answer. Fifty tonnes of flour and provisions have been “delivered” to orphanages in the province. They will in any case not make a great difference to the survival of a nation. Will they be diverted to some organisations in favour of others, or sold on the open market? We don’t know. What is certain is that the authorities allowed us to do it. Nobody was deceived, and that is perhaps where the real hope lies that something is changing. Let’s wait and see.

INTERVIEW

During 1999 we explored a great number of routes with Marcel. To begin with, they were very “official” routes, because in early 1999, humanitarian aid had slightly diminished. With MSF’s withdrawal in particular, and the publicity surrounding it, the United Nations had increasing difficulty in raising funds for North Korea; for years the country had not been in a very good state of health. At that time, Kim-Jong-Il authorised provinces to seek aid on their own account, and since Pyongyang was no longer redistributing it, the provinces kept it for themselves. They were more or less left to themselves and it is was then that within the framework of our networks we were approached by the province of Hamgyong, asking us to try to bring aid directly to it. A deliberate dialogue of the deaf ensued between us. They were perfectly aware that we were MSF, and we were perfectly aware that they knew, but we did not say so, because they could not take it upon themselves, vis-a-vis the central government, of negotiating with MSF. But in the meantime, they were in need of our aid. All this remained unspoken throughout our negotiations.

On their advice, we identified a Chinese company in whose name all the invitations were issued, and the evidence supporting applications for visas and foreign currency provided. We were employed as consultants to this company, we went under our own names, but at no point did we say we were MSF. We decided to use this company as a “cover” to make life easier. But it was also easier for them because it would have been difficult for them to justify the fact of having invited us to come, of welcoming or even meeting us. Our discussions were spread over several months, with trips to and fro. At one moment, they would say they would see. And so they would go back to North Korea, then there would be silence for several months. Then they would come back, saying: ‘agreed, but the people in charge of us demand such and such a thing.’ We did not negotiate directly with the provincial leader, the Governor, but through an intermediary.

When we went over there, we brought aid, in particular, a large consignment of rice. We organised small-scale deliveries by road across the Chinese border. Later we worked together on a project for public canteens in the province, which did not work out in the end. After a short time, trust broke down and then we said to ourselves that we shouldn’t go on. At the time, a team from MSF Holland was working in China. Dick van der Tak, its Coordinator, had been made aware of the issue, and we shared information. When Marcel and I left under cover of a Chinese company in North Korea, I told Dick about it, because I didn’t want the Dutch section to find itself in an embarrassing situation on account of the French section without knowing all the facts. The fact that he had been kept informed meant that he could accept it from us, whereas he could not have done so if he had been kept in the dark. Nevertheless, they do not support our initiatives, and we will never work together operationally. On the other hand, we try to keep them informed, as we do in the case of MSF Hong-Kong.

Sophie Delaunay, Research officer, Foundation MSF France, June to August 1998; Coordinator, MSF France in China, January 1999 to December 2001 (In French)

On May 1999, a DPRK official stated to WFP visitors that 220,000 North Koreans had died from malnutrition between 1995 and 1998.

DOCUMENT

“North Korea Admits 220,000 Deaths due to the Famine,” Le Monde (France) Tokyo, 12 May 1999 (in French).

Extract:

For the first time, four years after the beginning of the famine, the Democratic Popular Republic of Korea (DPRK) disclosed that more than 200,000 people had died from malnutrition. Jon In-chen, Director of External Affairs for the committee responsible for handling the damage done by the famine, told members of a delegation from the World Food Programme (WFP) who were visiting the region of Komusan, about fifty kilometres from the Chinese border, that between 1995 and 1998 the death rate had risen from 6.8 to 9.3 per 1,000. That would mean an increase of 55,000 deaths per year (or 220,000 people if we use the official population figure of 22 million). Experts are sceptical about this official report of the number of deaths. It is well below the estimates made by international bodies and non - governmental organisations providing assistance to the DPRK, who report three million deaths. These figures are disputed by Pyongyang.

On 24 April 2000, while a meeting between North and South Korea Presidents is taking place, the US weekly Newsweek published an article by Marie-Rose Pecchio, former MSF Coordinator in North Korea, in which she raised awareness about the fate of the ‘socially deprived children’. She also stated that MSF was ready to resume activities in North Korea, under the provision that its team could have access to those in need.

DOCUMENT

“The Mystery Children,” by Marie-Rose Pecchio, Newsweek (USA), 24 April 2000, (in English).

Extract:

Will the summit between Kim Jong II and Kim Dae Jung help the North Korean people? Pyongyang’s record is not good. From July 1997 to September 1998, Médecins Sans Frontières worked in four provinces of the Democratic People’s Republic of Korea-South Pyongan, Kangwon, North Hwangae and North Hamyong. Our doctors were implementing a medical and nutritional project, aimed at helping the people who were starving throughout the country. We ran into such bureaucratic brick walls that we eventually left the country in frustration.

Our most upsetting experience was our effort to help 600 children with mysterious backgrounds. Most of the children who came to our therapeutic feeding centers arrived with their mothers. They were starving but had families watching out for them. Yet over the 10 months we worked in two hospitals in the city of Pyongsong in the South Pyongyan province, we noticed groups of children arriving sporadically - we counted 600 without parents. Their nutritional condition was worse than the others. They suffered from serious skin diseases, suggesting exposure to the elements. They arrived together and, curiously, left together after a week or two of treatment. Were they street children? I had seen such kids from the windows of trains and cars, gangs of 10 or 20, standing around outside shutdown factories or railway stations. Had they been left to scrape an existence in the streets after their parents had died in the famine? The medical staff would tell us little about who these children were. Where would they go to after they left our care? To re-education schools? These kids had clearly fallen outside the system.

The authorities in Pyongyang denied that these children existed. When we suggested they might be street children, officials curtly responded that the government takes care of all children. We said we were ready to undertake new projects with new funding to help these kids. The government cruelly used its starving children. At first, they were useful proof of famine for international visitors. But when we tried to actually help, they turned us away. According to the government, people were hungry because of floods, not economic collapse.

As far I know, the economic situation has not changed in two years. So what about these kids? How many are there now? Are they alive or dead? We could have given these children some help, but it was refused to protect the die image of a perfect communist world.

Médecins Sans Frontières is ready to begin work again in North Korea, but we must have access to those in need. I hope this North-South meeting will open the door for real. Pecchio was head of the Médecins Sans Frontières mission in DPRK from 1997 to 1998.

After MSF’s withdrawal from North Korea, MSF France continued monitoring the situation with a set up composed of Pierre Salignon, MSF France programme manager, Sophie Delaunay, Coordinator in China and Marine Buissonnière, Director of Programmes in MSF Japan. They collected information through refugees and networks of assistance while collaborating with them on the China/North Korea border to assist North Korean refugees in China. Fiona Terry, Director of Research for the MSF France Foundation, followed on the work of François [Jean]11 www.video.16 and supported the team through extensive research work on the flow of international aid to North Korea. She also gave some interviews to the press.

DOCUMENT

Minutes of from the MSF France’s Board of Directors Meeting, 29 September 2000 (in French).

Extract:

North Korea (Jean-Hervé Bradol, Fiona Terry)

In 1998, MSF decided to interrupt its activity in North Korea because it was apparent that the aid provided was not reaching those in greatest need and that this diversion resulted from the system established by the government. Since then, the country’s situation seems hardly to have improved: estimates put the number of victims of the famine at several hundred a year, and the balance of geopolitical forces was not favourable to a change of regime. In view of the gravity of the situation, MSF hoped to explore new ways of trying to do something, in association with China, Japan and South Korea.

Jean-Hervé Bradol: In the end it was through Chinese commercial networks that we were able to find opportunities to participate in sending very small quantities of food or aid to refugees. There is in fact a micro-network around the Chinese border, which can easily be crossed over a length of several hundred kilometres. In this part of China, the communities enjoy considerable political autonomy, linked with rapid economic restructuring, which is in turn accompanied by extensive activity on the part of ‘mafias.’ The number of North Korean refugees in this region is thought to be between 100,000 and 150,000. They fall into in three categories, which are treated differently: children are more easily accepted: they are housed in various types of orphanages and can be enrolled ‘clandestinely’ at school. Manual workers join the local labour force and women are ‘married’ to Chinese men. Intellectuals, who are seen as dangerous, are removed from this area, or even sent to other countries.

These small aid networks are essentially Protestant, and it should be borne in mind that one of their aims is to engage in large-scale evangelisation. Religion is also a marketplace; for example, a bishop had to pay $150,000 for permission to celebrate mass in Pyongyang. Over and above this mercantile or moral aspect, it was also important to realise that for many of the people we met, religious belief served as a means of resistance, giving them new energy and restoring meaning to solidarity. And so for them, liberty and the practice of religion are equivalent terms, and they find it hard to understand why in France church attendance is so low, when there is nothing prohibiting it.

That said, in the Chinese context it is more a question of tolerance, counterbalanced by periodic raids, in which Koreans are sent back to North Korea and their Sino-Korean supporters financially penalised. UNHCR has not been able to insert itself in the region because it is still entangled in a dispute with the Chinese authorities, who insist on seeing the North Koreans solely as economic migrants and most important, not as refugees. For the time being, MSF is giving small amounts of financial aid to these Protestant micro-networks, with all the contradictions that presents for us, but its primary objective is to increase the number of visits, in order to gain a better understanding of what is happening, when that is hard to discern, given the clandestine nature of these initiatives.

Fiona Terry: I have just come back from a fifteen-day visit to these Christian networks. In our estimation, among the groups of active people whom we met, the desire to help the North Koreans was greater than the wish to convert them. A proposal is therefore being studied whose purpose is to offer short courses of medical training (a doctor would spend three weeks there every three months) and to give financial support for food provision. The training aspect would enable us to form practical links, to test the opportunities for working together and to continue to document the aid system in North Korea.

Marc Le Pape: I am worried, and I am wondering whether the people we are working with and who carry the Bible with them are not discriminating on religious grounds between Christians and non-Christians.

Fiona Terry: We do not underestimate this risk, because it is a real one, and can be seen particularly clearly in the favouritism shown toward Koreans as against Chinese, though they are not necessarily in greater need.

DOCUMENT

“Group Questions Motive Behind North Korean Aid,” Ko Hirano, The Japan Times (Japan), 10 March 2001 (in English).

Extract:

Terry said, however, that the aid is more likely to help Japan achieve its goal of normalizing ties with North Korea than alleviating food shortages in the country, unless Tokyo is able to “independently assess the needs of the population and give aid directly to people and monitor and evaluate the impact of that aid.” Tokyo and Pyongyang have held a number of talks on opening diplomatic ties since 1992, most recently in October. But the two sides remain at odds over several issues, including Pyongyang’s demand for an apology and compensation from Japan for its colonial rule of the Korean Peninsula and Tokyo’s demand for action on its allegations that North Korean agents abducted a number of Japanese in the 1970s and 1980s. A Japanese government official said Japan can do little about tracking the distribution of its rice aid because Tokyo and Pyongyang do not have diplomatic ties. “But we believe it is necessary to conduct a survey on how our assistance is distributed in North Korea in the near future,” he said, without giving details.

Terry, an Australian, said the Nobel Peace Prize-winning MSF withdrew from North Korea in 1998 because the North Korean government did not respect its with to work directly with local people. “We want to see patients and be able to assess what the needs of patients are as well to be able to help (North Korean) doctors. But we were never able to do this,” she said. “We are not interested in just delivering drugs to hospitals. We are interested in contact.” Terry said that when MSF members questioned North Korean doctors, they seemed to say only what they had been told to say, mediated through official translators. “If we asked a question or spoke about something that the (North Korean) government was not happy about they just didn’t translate,” she said. “I would like to see the Japanese government trying to understand what ‘humanitarian’ means a lot more.”

We very soon realised, after the mission to Seoul and on the border in summer 1998, that the core of our activity – if we had to have one – would take place with refugees. It is too difficult to carry out activities openly in North Korea. We continue to pursue it for form’s sake, but we know that we will never be completely comfortable with that kind of approach. There are two countries, China and Japan, in association with whom we are trying to explore operational alternatives. Japanese NGOs are involved in aid to North Korean refugees. In Japan and China, we are trying to explore operational avenues. I have been taken several times to meet partners in South Korea, since most of the networks are in South Korea. In Paris, the work of François [Jean], later continued by Fiona [Terry, Director of Studies at the MSF France Foundation] is to document, and to encourage speaking out. As we often go to the border, we interview refugees and as soon as we have enough material we send it to Paris to be integrated into their research work. During the winter, we took Fiona with us to the border. We worked closely together at that time.

Sophie Delaunay, Research officer, Foundation MSF France, June to August 1998; Coordinator, MSF France in China, January 1999 to December 2001 (in French).

INTERVIEW

We wondered how to renew our activity. There were discussions with François Jean on the idea of writing a comprehensive article, and then gradually, in late 1998 and early 1999, we said were going to try to work outside the country, and to pursue our work with China. Little by little, contacts were made with other NGOs in Japan, and that led us to act with South Korea, Thailand and Cambodia. Sophie and Marine did everything. They were very creative in the operational area.

Pierre Salignon, MSF France programme manager, from October 1997 on, then MSF France Executive Director from January 2004 on (in french).

In June 2001, the Chinese authorities organised a major crackdown on refugees on the North Korean border. In July 2001, MSF called on the Chinese government to cease forced repatriation and allow humanitarian assistance for the refugees, and simultaneously continued to denounce the manipulation of the international aid by the DPRK regime.

DOCUMENT

“Criminals…Like Rats Running Away,” by Jonathan Watts in Tokyo, The Guardian (UK), 23 July 2001 (in English).

Extract:

Aid workers who have been secretly helping starving North Korean refugees have broken their silence to protest against a crackdown by China which threatens the lives of tens of thousands sheltering along the border between the two countries. In the past six years many North Koreans have fled a famine estimated to have killed more than 1m people. China, which maintains friendly relations with the Pyongyang regime, treats them as illegal immigrants. This has forced church groups, Sino-Korean families and international aid agencies to work under cover to provide food, clothing, medicine and shelter.

These covert relief operations have come under intense pressure since June when China launched a “Strike Hard” campaign which has involved a sharp increase in the number of aid workers arrested and fined and refugees repatriated, many to face death or imprisonment. With the situation deteriorating every day the aid agency Médecins sans Frontières has broken cover to voice its “grave concern” at the attitude of the Chinese authorities. “What we’ve seen and heard is that there is a new policy that is putting large numbers of people in jeopardy and making it almost impossible to carry out even the silent kind of support local networks have been giving,” an MSF volunteer who has just visited the border said. [...]

This prospect has created an atmosphere of terror among the refugees. “People are scared. They are afraid to talk, afraid to meet,” the MSF volunteer said. “The crackdown means they have to go into even deeper hiding - they cannot go out to work, they cannot even go out to beg. On top of that, the people who are supporting them are coming under pressure, so they are running out of options.” Why China has chosen this moment to act is uncertain. One possible explanation is that it fears a surge of refugees across the 550-mile border as conditions deteriorate. Estimates of the number of North Korean refugees in China range from 10,000 to 500,000. MSF says it is probably about 200,000.

DOCUMENT

“China Steps Up Repatriation of North Korean Refugees” by John Pomfret, The Washington Post (USA), 23 July 2001 (in English).

Extract:

The report, citing refugees’ accounts, said those sent back to North Korea faced reprisals ranging “from interrogation, re-education and imprisonment to capital punishment.” The report said the repatriation campaign reached its climax after a North Korean family of seven sought refuge at the U.N. refugee agency’s Beijing office last month. Under intense international pressure, China allowed the family to leave the country, and they ultimately went to South Korea. China made the decision right before its successful bid to host the 2008 Summer Olympics, prompting speculation that the decision was made to mute criticism of its human rights record. It is not known how many people have been repatriated since the campaign began in May, but the group estimated that it is in the thousands.

“Refugees and aid workers report an increase in the number of arrests and forced repatriation since the beginning of the campaign,” the report said. “A resident living in one of the border cities reports that 50 people are being repatriated here every other day, compared to 20 per week in the past.” Tens of thousands of North Koreans have fled to China, mostly in search of food. A famine caused mostly by bad agricultural and economic policies has ravaged North Korean since 1994, causing an estimated 1 million to 2 million to die out of a population of 22 million. Last year, China forcibly repatriated another North Korean family; even after U.N. refugee officials had determined that they would face persecution if they were sent home. U.N. refugee officials accused Beijing of violating the U.N. covenant protecting U.N.-designated refugees from forced repatriation, which China has signed.

Doctors Without Borders pulled out of North Korea in early 2000 when it was denied access to some of North Korea’s poorest people. Several Western aid agencies have said the North Korean government refuses to allow food aid to be distributed to the neediest people, but channels it instead to families tied to the ruling Korean Workers’ Party, the military and workers considered necessary to maintain Kim Jong II’s government. Some aid agencies said Western governments have been reluctant to criticize this practice because their main concern is that North Korea maintains its moratorium on missile tests. North Korea fired a two-stage rocket over Japanese airspace in 1998, prompting widespread concern that it had a program to develop intercontinental ballistic missiles. North Korea was also believed to be working on a design for a nuclear warhead.

Citing comments by witnesses and interviews in the region, the Doctors Without Borders report said that signs posted this month in the border town of Longjing warned people that they would be severely punished for helping North Korean refugees. Police have set up checkpoints to document the identities of people in minibuses and taxis, have entered factories and other workplaces to inspect identity papers, and conducted house-to-house checks to verify residence permits, the report said. “North Koreans are living in constant fear of being caught in the net of a systematic search, arrest and repatriation policy,” it said. “The Chinese population is being mobilized, with the offer of rewards, to report on the presence of North Koreans,” it added, saying that fines for helping refugees ranged from $500 to $4,000.

DOCUMENT

“China Accelerates Repatriations of North Koreans,” Mark O’Neil, Beijing, The South China Morning Post (China), Beijing, 25 July 2001 (in English).

Extract:

The government of the northeast China province of Jilin has increased forced repatriations of North Korean refugees as part of the “Strike Hard” anti-crime campaign and refused the offer of humanitarian aid for them, Médecins sans Frontières (MSF) said yesterday (Tuesday). [...] In an interview in Beijing, an MSF volunteer back from the North, said that this month his organization had for the first time asked the Jilin government to provide assistance to the North Koreans there because MSF was concerned about the refugees’ health conditions. “It was difficult to obtain meetings on this subject. When we had meetings, with officials in public health, civil affairs and foreign affairs, they said that there were no North Koreans there and therefore no problem.” “They know the reports in the international press and accuse it of lying,” he said.

MSF is active in six provinces and regions of China, with about 30 expatriate staff and 120 local employees. “We are warmly welcome anywhere but in Jilin,” he said. In late June, China allowed a family of seven North Koreans who had taken refuge in the Beijing office of the United Nations High Commissioner of Refugees to leave China and go to South Korea, via Singapore. This led to hopes that Beijing would change its policy and consider the North Koreans as political refugees but officials later said that this was not a precedent and that its policy of forced repatriation remained in place. The MSF volunteer said that, following the family’s departure, the authorities in Jilin had stepped up the level of such repatriations, as part of the “Strike Hard” campaign, with arrests, house-to-house searches and fines of aid workers who mainly consist in Korean-Chinese Christians and Buddhists.

[…] In one night in late June, 4,000 people, including North Koreans and illegal Chinese migrants, were arrested in Yanji city.

“For the past two years, we did not wish to talk too much about this, to protect both aid workers and refugees. But our silence was vain. It is unacceptable to pursue the starving North Koreans and send them back.” The minimum punishment they face is one month of prison and interrogation, rising to long sentences or death if they are shown to have had contacts with Christians or South Koreans who are all regarded as ‘spies’. “China cannot admit their refugee status. If it did, it would have to recognise the failure of the North Korean system,” he said.

MSF withdrew from North Korea in September 1998 after working there for three years because it was dissatisfied with the distribution of its aid, saying that most of it went to members of the ruling Workers Party, the army or senior officials and not the most vulnerable population from whom it was intended.

DOCUMENT

“Engineered Famine in North Korea,” Philippe Grangereau, Libération (France) 30 July 2001 (in French).

Extract:

North Koreans are continuing to die of hunger despite the massive international aid delivered to the Pyongyang government by the United Nations, because the government is leading international organisations by the ear, and diverting a proportion of that aid. Those are the conclusions of Fiona Terry, Director of Research at Médecins Sans Frontières (MSF) who presented them to Libération. In order to find out what was happening in the land of the ‘Great Leader’, where the regime excludes all independent newsgathering, MSF carried out a study in China, which lasted several weeks. It was based just across the border with North Korea, where between 100,000 and 200,000 North Koreans are seeking refuge from hunger and repression.

Fiona Terry used these testimonies in her description of daily life in the world’s last ‘Stalinist’ dictatorship: “The Mercedes of the North Korean elite drive back and forth through Pyongyang, while ordinary citizens are reduced to digging up the grass along its five-lane boulevards in search of edible roots and plants. The public distribution system, on which three quarters of the population depend, provides rations only on important dates such as the birthdays of Kim II-sung and Kim Jong-Il, and for the rest of the time leaves people to get by as best they can. The testimonies of North Korean refugees in China collected by local organisations suggest by extrapolation that 3.5 million people may have died of hunger and from diseases linked with the famine of 1995-1998.”

A shock? The situation has hardly improved since then. “The refugees still speak of people dying of hunger, but less frequently, reports MSF’s representative. They say that the weakest – the old, the very young and the sick – are already dead, which leaves fewer mouths to feed with the little that is available. Imagine the shock if one day we discover that there are not 23 million North Koreans, as the government states, but only about fifteen million, as some North Korean ex-officials who have fled to China believe.”

MSF left North Korea in 1998, after working there for four years, followed by Médecins du Monde, Action Against Hunger and Caritas. These NGOs believed that food aid was not going to those in direst need: “Our teams realised that the regime was putting on show whatever it wished humanitarian workers to see: malnourished orphans (when it wanted increased food aid) and healthy children to reassure donors of the effectiveness of the actions that had been undertaken”, reported MSF. This type of manipulation persists. “Some refugees report transporting food to nurseries from army depots just before the arrival of a UN inspection visit. Others say they were mobilised to take part in excavation works with the purpose of aggravating the effect of floods, in expectation of a UN inspection visit.” The official position is, in fact, that the famine was caused exclusively by ‘natural disasters’.

A case of social Darwinism? Fiona Terry further states that she “understood that Pyongyang divides its population into categories: those seen as loyal or useful to the regime, and those judged hostile or without use, which it believes it can do without” – an extreme form of social Darwinism that no longer surprised her. “Kim Jong-Il even declared publicly in 1996 that it would be enough if 30% of the population survived, so that a victorious society could be rebuilt.” But how are we to explain the silence and passivity of UN bodies such as the World Food Programme (WFP), which supplied North Korea with a million tonnes of food a year, making that country one of the most heavily assisted in the world? For several years, the WFP has officially been supposed to be meeting the needs of the 8 million North Koreans thought to be most vulnerable. But many of the refugees interviewed by MSF say they had never benefited from such aid. “Nobody knows what happened to it”, says MSF. The finger had already been pointed at WFP in June by the UN’s Special Rapporteur on the Right to Food, Jean Ziegler, who stated that the bulk of the aid supplied between 1995 and 2000 was “diverted by the army, the secret services and the North Korean government.” WFP’s spokeswoman, Catherine Bertini, retorted, “the statement on the diversion of aid “is groundless, and does not correspond with what we observe in the country itself.”

“Although their aid is described as humanitarian, donor governments and aid organisations have given North Korea this ‘transfusion’ for political, economic and diplomatic reasons,” claims MSF. The United States, Japan and South Korea wish to avoid the collapse of the regime, a development that could lead to military action or cause a haemorrhage of refugees into China and South Korea. As Fiona Terry sees it, “The goal of humanitarian aid may well be to save lives, but to entrust its distribution to a government guilty of aggravating suffering makes it an element in the system of oppression.”

‘Rats’. Those North Koreans who escape the famine by fleeing to China are not out of the woods. MSF notes that for several weeks the Chinese government, in concert with Pyongyang, has been intensifying the forced repatriation of these refugees, whom it hounds down, describing them as ‘criminals’. A police leaflet issued on 21 May, encouraging people to report them, compares them to ‘rats running through the streets’. Beijing, which at best calls them ‘economic migrants’, refuses to give them refugee status. In the past few weeks, transfers across the border have risen on average from 10 to 25 a day. Those deported face interrogation, re-education camps, prison, and even the firing squad.

“In mid-July we expressly asked the Chinese government for permission to bring help to these North Korean refugees in China”, reported MSF’s programmes officer, Pierre Salignon. “We are awaiting its reply.”

DOCUMENT

“It is Wrong to Say That Aid is Being Diverted,” interview with Catherine Bertini, Director General of the World Food Programme, by Pierre Haski, Beijing correspondent, Libération (France), 30 July 2001 (in French).

Extract:

Passing through Beijing on her return from North Korea, Catherine Bertini, Director General of the World Food Programme (WFP), who is responsible for the delivery of aid, emphasised that in view of the severe drought, there would be no improvement in the country’s food situation this year, even if, individually, those receiving aid are in better health. Last month, however, Médecins Sans Frontières (MSF), on the basis of personal reports by refugees arriving in China, stated that aid was not reaching those for whom it was intended, and that the WFP showed that it was conniving with the North Korean ‘system of oppression’ (Libération 30 July). In an interview with Libération in Beijing, Catherine Bertini defended her actions and stated that food aid handled by the WFP was indeed reaching those for whom it was intended. [...] If they were not receiving food, they would show the effects. But they are in reasonably good health and more of them are going to school than two or three years ago.

- But you are still obliged to announce in advance where you are going. That is not the case with other WFP operations.

- Yes, we do that; the government does not allow us the same access that we have in other countries. I would never say that our verification system is working as we would wish, that is not the case. But then to say that for that reason, aid is being diverted, is wrong.

- Why accept the North Korean government’s conditions?

- If you don’t accept them, you can’t feed the children. And that’s our mission. Our aim, since the beginning of our operation in 1995, is to guarantee every North Korean child the chance to grow up.

- MSF speaks of manipulation, of ‘set-ups’

- We visit many places. We have stopped sending aid to hospitals because our monitors had the feeling that things were being ‘set up’ when they went there. But you cannot speak of ‘set-ups’ when we go back to the same schools and see the children’s progress. Is everything always honest and transparent? It certainly isn’t, but we are sure we are succeeding in helping people in the places where we are able to go. Our worries are more for the districts where we cannot always go, officially for reasons of security, a total of 44 out of 211. What is happening there? We don’t know.

- Isn’t there a contradiction between this regime’s high military expenditure and the fact that a third of its population depends on international aid?

- Absolutely, and it is true of too many places in the world, not only of North Korea. But if we decided that we aren’t going to help them because we don’t approve of their military budget; that would be an immoral position.

- Is your position then, that whatever they do, as long as we feed the children, we’re morally correct?

- I’m simply saying that the idea that we should allow these children to die of hunger because we don’t like this government is an immoral idea. It is an idea that no humanitarian individual would defend, nor, for that matter, any humanitarian or government in the world. From Bangladesh to Canada, I have never met anyone who said, “Let these children die because we want this government to change.” Never. And if the leading donors (United States, Japan, South Korea) think aid has been diverted, do you think they would continue to pay? That is not the case.

- In your opinion, is the Pyongyang government taking the smallest measures to avoid being permanently dependent on food aid?

- No. North Korea will remain dependent on food aid for the foreseeable future.

DOCUMENT

“Update MSF and NK,” Email from MSF Beijing to MSF Belgium and MSF Holland North Korea network, 3 August 2001 (in English).

Extract:

Dear all,

Thanks to all of you for your interest and great support on the NK issue. You will find in this email a bit of background info on our strategy for this very sensitive NK story, as well as an update on the latest development, so as to facilitate communication among ourselves and have you share a bit of the ‘local’ atmosphere. Summary of MSF background on the NK issue since 1998.

1. Since MSF withdrew from North Korea in 1998, actions have been taken from MSF Japan and MSF China to identify some alternative ways of assistance and keep documenting the sanitary situation inside the country. Through contacts made at field level (Sino Korean border), and in the region (Japan, China, South Korea, Thailand), we have gradually gathered information about the conditions inside NK and on the border and investigated on the general environment conducive to the crisis. Today, this operation is run by Sophie (MSF China) and Marine (MSF Japan), under the supervision of Pierre Salignon in Paris. Info collected has been systematically transferred to Paris, and Fiona Terry (MSF Foundation) is in charge of research work. On a regular basis, testimonies of refugees have also been given out to reliable journalists in Beijing, Tokyo or Bangkok, but until the month of June, we did not feel the need of having MSF quoted in the press.

2. As time passed by, we have got to know more and more about the situation of the NK people, especially of those who try to escape from their country and seek asylum and assistance in China. Although the Chinese repression toward NK refugees has existed continuously over the last 3 years, the necessity of protecting local aid workers and their beneficiaries, combined with the opacity of the border, has made it difficult to address the issue of forced repatriation and lack of humanitarian access. Following the Guilsu incident at the end of June 2001, rumours spread about a major crackdown on the Sino Korean border.

We took the decision to go to the border in order:

a) To crosscheck info about increasing number of forced repatriations.

b) To present an official request to the Chinese local authorities for assistance to this population. This field trip provided substantial evidence that the crackdown on NK refugees had indeed taken place and that the hunt was being pursued. Requests made at official levels were unfruitful, the Chinese authorities denying the existence of NK refugees, and therefore the need for any kind of MSF involvement.

Circumstances and scope of MSF public position:

Media

At the beginning of July, we presented the outcome of our investigation and proposed to address the issue publicly and in MSF name. Paris supported this idea, and other sections involved in operations in China (Holland and Belgium) agreed on this initiative.

Then the following strategy of communication was decided:

1. Express MSF concern regarding the lack of access to NK refugees and forced repatriations

2. Target a panel of reliable journalists with whom we have already been dealing, on this issue.

3. In order to protect existing operations in China, avoid mentioning field people’s name or the nature of MSF activity on the border but rather express MSF general position.

4. Interviews with the designated journalists were to be made either by Pierre, Fiona, Marine or Sophie, who are the 4 persons involved in this issue.

5. Since radio interviews require naming the interviewee, they would be made by Pierre or Fiona in Paris.

We favoured a gradual approach. Our idea, as a first step, was to address our message publicly in a (rather) smooth and controlled way in order to push for a dialogue with the Chinese... avoid being kicked out right away. To prevent as much as possible our message from being distorted, we made a point to brief individually all the journalists that we had identified.

The following media reported MSF statements: The Guardian, Asahi Shinbun, The Washington Post, The South China Morning Post, Libération, AFP, Japan times, the Chosun Ilbo. Articles are still to be released in Le Monde, and Sankei Shimbun in the coming days. Pierre did some Radio interviews as well. Pierre and Fiona have been invited to a French TV broadcast ‘des racines et des ailes’ [roots and wings] due to be broadcasted in September.

Other actors

Before making our appeal, we met with the President of China Charity Federation in Beijing and asked for his support in helping us find a space for assistance. He is working on it. UNHCR, EC, French embassy, and South Korean Embassy in Beijing were approached as well. All of them expressed great concern but showed no willingness to move further (except EC which proposed to send a memo to Brussels). Simultaneously with the press approach, the issue was supposed to be addressed in EC Brussels (Pierre Salignon and Alex Parisel) and UNHCR Geneva (Pierre or Fiona). This week, Catherine Harper from MSF USA raised briefly the issue in New York with the Chinese ambassador of the UN Security Council. Another contact is to be made next week.

Impact of MSF appeal

There has not been any direct or indirect reaction from the Chinese government yet. The SK Ministry of Unification Seoul has expressed great interest in MSF statements, and wishes to share our information regarding the use of humanitarian assistance inside NK. The press has however been quite reactive and requests for information and interviews are received almost everyday, mainly through MSF delegate offices.

6. At this point, we do not feel comfortable in further diluting MSF’s appeal and take the risk of losing control of our message. The reasons are:

1. It is obvious that the Chinese have already received our message.

2. It seems that HR [human rights] related media is very eager to bring and join the MSF message. This of course, is not a criticism, but the HR issue is an epidemic one for the Chinese and if addressed as such is doomed to be rejected. We have until now managed to focus on humanitarian concern, which is strong enough, and allows us to keep claiming for discussion.

3. Before deciding to intensify our public statement, we would like to have a few weeks’ break to approach the Chinese officials again and test their capacity of response. If there is no improvement, nor any prospects by the end of august, we suggest discussing amongst ourselves about a new strategy of communication. August being vacation time, there will always be time in September to strike again. We will keep you informed about the coming developments. Please feel free to contact us by email. We are sharing all information on this matter, but to avoid any gap and loss of time, please send a copy of your comments or questions to both of us.

All the best!

Marine and Sophie

DOCUMENT

“Feeding the Dictator,” by Fiona Terry, Researcher for Médecins Sans Frontières, The Guardian (UK) 6 August 2001 (in English).

Extract:

Kim Jong-Il, North Korean leader, bought £300m worth of weapons from Russia at the weekend. Meanwhile, at home, million of this people are starving to death. North Korea, the last bastion of Stalinism, is in the grip of an economic crisis that has provoked famine in many parts of the country. Yet the regime maintains the budget for its 11 m-strong defence force. While monuments to the grotesque personality cult of Kim Jong II and his dead father, Kim II sang, are floodlit, apartment blocks in the showcase capital, Pyongyang, are without electricity. Rural areas have abandoned tractors and reverted to ploughing by hand over with livestock. Mercedes Benz belonging to the ruling elite ply the streets of the capital while ordinary citizens dig for roots and edible plants to the grass strips lining the five-lane boulevards. The public distribution system, on which three-quarters of the population depend for food, only provides rations on important dates, like the birthdays of Kim II-sung or Kim Jong-Il.

Extrapolations from testimonies of North Korean refugees in China suggest that up to 3.5m people might have died from starvation and related illness between 1995 and 1998. Reports of deaths continue to permeate the border, although with less frequency now: the refugees say that the weakest have already died – the elderly, the young and the sick – leaving less mouths to feed from the meagre food available. All this takes place while North Korea receives one of the largest allocations of food aid in the world – almost 1m tonnes annually. This food, mostly channelled through the UN World Food Programme (WFP), supposedly targets 8m of the most vulnerable North Korean: school children, pregnant and lactating women, the elderly and sick. Yet refugees in China from the hard-hit northern provinces where WFP concentrates its aid say they never received this food, despite being from the hard-hit northern provinces where WFP concentrates its aid.

What is happening to the food aid? No one knows, not even the organisations in charge of distributing it, because the North Korean regime does not allow aid agencies the access necessary to ensure that aid is reaching those for whom it is intended. All aid is channelled through the government-run public distribution system, effectively strengthening one of the main instruments of control at the government’s disposal. Aid agencies are permitted to “monitor” the aid, but must announce monitoring visits one week in advance; no random visits to households, kindergartens or schools are allowed. Aid workers have little contact with ordinary North Koreans as a government translator accompanies them wherever they go, and questions deemed controversial are left untranslated.

Médecins Sans Frontières (MSF) endeavoured to overcome these restrictions and create the minimum conditioning necessary to work decently in North Korea between 1995 and 1998, but was unsuccessful. The teams realised that the government fabricated whatever they wanted aid workers to see: malnourished children in nurseries when more food aid was desired, and well-fed children when donors needed reassurance that food aid was doing good. Refugee testimonies corroborate this: some report having carried food from military storage to nurseries before a UN visit, and others speak of being mobilised to dig up areas to exacerbate flood damage in preparation for a UN inspection. MSF began to understand that North Korean government categorises its population according to perceived loyalty and usefulness to the regime, and those deemed hostile or useless were expendable. In fact, in 1996, Kim Jong-Il publicly declared that only 30% of the population needed to survive to reconstruct a victorious society. With no possibility of directing aid to those most in need, MSF withdrew.

Although they label their humanitarian aid, donor governments and aid organisations keep North Korea on life support for political, economic and diplomatic reasons. The US, Japan and South Korea are pursuing a “soft-landing” policy aimed at avoiding an implosion of the regime which could trigger military action or refugee flows into China and South Korea. Food aid is aimed at opening dialogue and trust to pave the way for controlled reunification. Other governments, such as Australia, hope to improve ties with the regime for future trade benefits. Most members of the EU – including Britain, which opened an embassy in Pyongyang last month – have re-established full diplomatic relations with the regime, thereby bestowing legitimacy on Kim Jon-Il and his clique. While political and diplomatic engagement provides the only real means to influence the regime, using food aid to do so in a country beset by famine is reprehensible. The purpose of humanitarian aid is to save lives. By channelling it through the regime responsible for the suffering, it has become part of the system of oppression.

INTERVIEW

Raids on North Korean refugees take place regularly, and we are keeping a close eye on these questions. At certain points, we find it is important to react and we take advantage of it in order to raise the question of aid in North Korea again. Fiona is doing a huge piece of work on WFP and we are trying to show that WFP’s aid is almost in excess of needs and that there should therefore be no famine. We show that the combined aid of WFP, China and all the various actors should be broadly sufficient to feed the whole of this population because the statistics provided officially are underestimates, say the refugees we have interviewed. Fiona will focus on this subject for two or three years. For these three years, finally, we will not speak out in directly denouncing North Korea. We believe there is no more to say to North Korea, no lessons to offer them, since we are not even present inside the country. On the other hand, we continue to offer lessons to WFP, because we are documenting aid. WFP tells us that it is providing millions. Our answer to them is that we have refugees who come from such or such a city or province where the WFP is supposed to have distributed aid, and those refugees have received nothing for three months. It is Fiona’s job to collate WFP’s declarations with the statements of the refugees, on the basis of the interviews we are carrying out.

Sophie Delaunay, Research officer, Foundation MSF France, June to August 1998; Coordinator, MSF France in China, January 1999 to December 2001 (In French)

INTERVIEW

In these notorious provinces where international aid is supposed to be arriving en masse and reaching the most vulnerable (on paper at least), we continue to gather reports from people who have seen no international aid apart from what they have transported to stores, to supply the army’s needs. United Nations bodies and certain humanitarian organisations declared they had brought assistance to the most vulnerable, in kindergartens, maternity clinics and hospitals, and to the elderly – in other words to all categories of vulnerable people. But it is obvious that assistance has not reached those who have gone to China.

Many a time, we (and other people in MSF as well) had exchanges with Catherine Bertini, WFP’s representative at that time, and with various WFP officials of different grades. They told us that the most vulnerable were being helped, because they were providing food to this or that body in which those people were supposed to be found.

We then went back to see them with a list of interviews with refugees who had come from such or such a place – places supposed to be covered by the WFP – and told them that these refugees had received nothing. In the case of WFP people, we very quickly found ourselves having a surreal discussion. When we showed them the names of the institutions in which aid from WFP was officially said to have been distributed, we realised that they had no list of the institutions they were supposed to cover. In fact, to the best of my knowledge, they still did not have one very recently. In this situation, it is hard to say that the most vulnerable are being reached, or to know where the assistance is going. It is problematic!

We had the results of the famous UNICEF-WFP 2002 enquiry into nutrition in North Korea analysed by Epicentre. We were trying to identify possible biases in the methodology. We went back to see UNICEF and the WFP with this material, in an attempt to have a thorough discussion of our understanding of the nutritional situation in North Korea. When we came to the representative’s office, as soon as we raised the first question, she stopped us right there and told us we were certainly right in terms of our material taken as a whole, because ultimately that enquiry had only been undertaken for publicity purposes, and was not based on epidemiological data. We therefore had an almost philosophical discussion on the usefulness of proceeding in that way. She explained to us that the way they reconciled themselves with the idea that in the short term they were certainly not reaching the most vulnerable was by convincing themselves that the more aid there was, the better the chance that what was not used by the authorities in normal times would reach the most vulnerable.

Marine Buissonnière, Director of programs, MSF Japan, April 2000 to September 2001; Co-Coordinator MSF France in South Korea, February 2002 to November 2003; (in French).

In 2002, MSF France extended its programme to assist North Korean refugees who were fleeing from China to other Asian countries in their attempt to reach South Korea. The MSF team established their office in Seoul, South Korea. They carried on sharing their information about the situation of the refugees with the international media’s correspondents based in Seoul, Beijing and Tokyo and lobbying on all possible fronts. On 2 May 2002, Sophie Delaunay, the MSF Regional Coordinator for North Korea delivered a testimony regarding the plight of the North Koreans inside DPRK and in China, to the House Committee on International Relations Subcommittee on East Asia and the Pacific of the Congress of the United States of America.

DOCUMENT

“North Korea: The Humanitarian Situation and Refugees,” MSF Testimony Delivered to the House Committee on International Relations Subcommittee on East Asia and the Pacific in Washington, D.C. by Sophie Delaunay, Regional Coordinator for North Korea, MSF, 2 May 2002 (in English).

Extract:

[…] MSF derives its current understanding of the humanitarian situation in North Korea from the following sources:

North Korean refugees in China

• North Korean defectors in third countries

• Aid workers providing cross-border assistance

• Lack of Access of the Most Vulnerable Populations Inside North Korea To International Aid

In October 2001, I described to a 40 year-old North Korean refugee how MSF used to provide aid in North Korea. After listening to my explanation, he smiled at me and said, “You cannot reach people like this… You can’t reach the common people.” His comment illustrates the striking discrepancy in information between aid agencies present in North Korea and aid workers assisting North Korean refugees about whether aid is reaching its intended targets. This has been a characteristic of the North Korean crisis for the past 7 years. MSF itself experienced such a divergence when in 1998, the extent of the famine described by the refugees that MSF met on the Chinese border could not be observed by its teams operating in the DPRK. This was due to the restrictions imposed by the North Korean government on the ability of aid organizations to independently assess humanitarian needs.

To this day, the vast majority of refugees who MSF has interviewed say they have never received food aid. This includes those belonging to the target beneficiaries of the United Nations program. Anyone who has sat and talked with these refugees would find it difficult to believe the assurances of the World Food Program (WFP), which is reporting that aid is saving millions of lives, and that they have access to the people and know where the aid is going. North Korea has been one of the largest recipients of food aid in the world for a number of years, yet it is still a great challenge for vulnerable populations to access food. Despite increased border controls, some North Koreans, mostly from the northern provinces, continue to cross into China in search of the means to survive. According to the refugees MSF has interviewed, the food situation remains critical for most of the ordinary people in North Korea. In their own words, after a decade-long food shortage in the country, those who remain are the survivors and only the strongest have learned to cope.

Even population groups such as children, pregnant women, and the elderly, who are specifically targeted by the WFP for assistance, are being denied food distribution. In February 2002, an MSF team met with 12 North Korean children between the ages of 6 and 15 who had recently arrived in China. None of them had ever received food at primary school. […] For MSF, the testimonies of North Korean refugees raise serious questions about the way humanitarian assistance is delivered in North Korea. From our point of view, two major weaknesses in the relief programs favour exclusion of vulnerable populations from the aid system. Those weaknesses are:

• The use of the Public Distribution System (PDS) to channel food aid; and,

• The quality of monitoring food aid.

The Public Distribution System

As early as 1998, MSF denounced the fact that any assistance channelled through the PDS was discriminatory by nature. By using the PDS as the distribution channel for assistance, organizations are collaborating in organized government discrimination of its own citizens based on politics instead of needs. […] According to individuals we interviewed, ordinary urban residents cannot rely on the PDS for their survival and are forced to find alternative ways to obtain food. Erratic for years, the PDS came to a virtual standstill in the late 90’s with meagre distribution on major national holidays.

The Quality of Monitoring Food Aid

After 7 years of massive international assistance to North Korea, monitoring conditions remain unacceptable. North Korea still does not provide the complete list of beneficiary institutions and WFP teams are still barred from making spot checks. Random access for assessment purposes appears to be impossible, calling into question the transparency of field inspections. Some refugees have witnessed UN visits and their testimonies raise questions over the way field inspections are organized, if not staged, by the North Korean partners. From its experience and understanding of the North Korean system, MSF would like to reiterate that access by the population to the aid needed can only be improved if there are independent needs assessments, independent distribution mechanisms, and independent monitoring by operating agencies.

The Lack of Protection and Assistance for North Korean Refugees

Once outside North Korea, challenges remain for North Koreans seeking refuge outside their country. Most North Korean refugees do not even contemplate reaching South Korea. Instead, they cross the border into China in search of food for their families, or a temporary job that will allow them to buy medicines or other essential goods needed at home. These refugees live in a precarious situation in China and are in urgent need of assistance. Considered illegal migrants by the Chinese authorities, they live in hiding and face the risk of being arrested at any time, forcefully repatriated, and subject to severe repercussions in North Korea. Border rules posted along the Tumen River in Chinese and Korean stipulate that, “It is forbidden to financially help, allow to stay, harbour, or aid in the settlement of people from the neighbouring country who have crossed the border illegally.”

Fines and rewards discouraging Chinese citizens from assisting North Korean refugees and recent arrests of NGO workers illustrate how impossible it is to adequately provide effective humanitarian assistance. Only a handful of refugees manage to reach a third country, where they continue to face the risk of being arrested anytime as illegal migrants during their 3-to-4-month screening process. Up to now, none of the 1988 North Korean defectors who have been resettled in South Korea have been granted refugee status.

Numerous discussions between MSF and the United Nations High Commissioner for Refugees (UNHCR) about the need for protection have not proved fruitful. In July 2001, MSF called on the Chinese authorities to cease forced repatriations and allow humanitarian assistance for the refugees. These calls have gone unanswered. The ongoing repression of North Korean refugees and of those who assist them limits the scope of any humanitarian operation on the Sino-Korean border. There may soon be no more refugees to tell you about North Korea.

Conclusion

The need for assistance to the North Korean people is widely acknowledged. Testimonies of North Korean refugees confirm that despite massive international relief going into the country, a significant segment of the population remains in a precarious food situation. These testimonies also suggest that humanitarian assistance is not primarily directed at, nor reaching, the most vulnerable populations.

MSF expresses its grave concern over the endless suffering of the North Korean people and urges aid agencies operating inside North Korea to improve their monitoring and be responsible for the populations they are entrusted to assist. A second concern addresses the dire plight of North Koreans seeking refuge in China. Médecins Sans Frontières urges UNHCR and the Chinese government to open a dialogue leading to ensuring protection of North Korean refugees in China, and to authorizing the provision of emergency assistance to the refugee population.

DOCUMENT

Minutes of the MSF France Board of Directors’ Meeting, 30 August 2002 (in French).

Extract:

Presentation Jean-Hervé Bradol [President]

The campaign of repression by the Chinese authorities (encouraging and rewarding informers, surrounding embassies with barbed wire, etc.), launched over eighteen months previously, was now targeting small networks, in order to break them up. These aid networks are mainly denominational, made up of Protestants, or more rarely, Buddhists. We maintain relations with these networks on matters such as shelter, food and health. We decided to contact the Chinese authorities to find out if there was a space for aid to refugees at the border. Sophie Delaunay (HoM Seoul) and Jean-Hervé went to Beijing to meet the President of the Chinese Charity Federation and a group of senior officials of the Ministry of Civil Affairs. The response was: “there isn’t a problem, we are dealing with it, and it’s going very well,” or “we are not authorised to speak on that subject.” After statements of that kind and despite attempts to reopen the discussion, there was no further possibility of addressing the subject. How are we to interpret a meeting like that? No hostility was expressed about the fact that MSF was expressing an interest in the subject. Our feeling was that the authorities had known about our interest in the subject for several years and continued to be pragmatic in the answers they gave us.

In order to keep track of the refugees, it seemed important to be present in South Korea. In order to do that, we decided to open a small office there. Sophie and Jean-Hervé had interviews at the Ministry for Reunification and with the director of the national centre responsible for accommodating refugees for a period of two months following their arrival in South Korea, in order to encourage their ‘integration’ into the country. There are not many refugees, but their numbers are increasing every year. The director of this centre suggested that we work in the institution’s medical departments. We also had discussions with the chief psychiatrist, who had an interest in North Korean refugees. In his view there were some people who were ill, but that the refugees tended not to seek this type of care, of which they have a negative image.

Discussion

Sylvie Lemmet: Why is the South Korean government inviting us to work with this organisation?

Didier Fassin: After all, France has asked the Red Cross to go to Sangatte – because that’s humanitarian!

Jean-Hervé Bradol: The South Koreans are open-minded and think that in a democratic society our presence makes sense. They are putting resources into this programme, which does not have the feel of a prison environment; on the contrary, there emanates from it a sense of care for patients – for example, they have proper activities: sewing, use of computers, and training, e.g., “what is a bank?”

Virginie Raisson: The transparency of the networks in China is low, and we must assume that the risk cannot be measured.

Jean-Hervé Bradol: People are often fleeing for reasons connected with economic difficulties, sickness and poverty. The North Korean refugees employ many different strategies; they are not all trying to stay in exile permanently, and many hope to cross at regular intervals in order to collect food.

Didier Fassin: This reception by Chinese authorities, which is more indifferent than optimistic, may also remind us of the insignificance of the part we are playing.

Jean-Hervé Bradol: Yes, it’s like flea on an elephant’s back!

Virginie Raisson: For much less than that, they refused to renew our passports for the province of Xinxiang and for Tibet.

Thierry Durand: Are people fleeing in the same way the ‘boat-people’ did?

Jean-Hervé Bradol: Some networks of activists think that may be happening.

Conclusion

Consultative opinion of the board of directors: The board supports the activity of the in-country team, including the sensitive aspects of its activity.

INTERVIEW

In China we had a large network of journalists to whom we gave information; we introduced refugees and activists to them, and they wrote their stories. Most of the time, we agreed that MSF would not be quoted by name. It was a way of protecting the China programme. During 2001, we spoke out publicly more frequently, and at the end of the year the Chinese began to dig in their heels, saying: ‘that’s enough of MSF.’ At that point, we had already tried everything. First the most thoroughly legal route available. We had met the authorities of Hwangae province in North Korea, and those of the three provinces of northeast China. We had seen the Red Cross, who stated they had never seen North Korean refugees; that there was no problem, and that everything was fine. Everyone was denying the problem at the very time that we were meeting refugees clandestinely; we knew they existed. We went right to Beijing, to try to meet the more open-minded central authorities, people who had been active in the uprising in Tienanmen Square, progressives who were now close to the government. Even those people clearly signified to us their inability to prohibit the process, in view especially of the ties of friendship between China and North Korea.

At that time, Korea was in a sensitive position vis-à-vis the USA over the nuclear issue, and Russia was trying to go down the road of negotiations, which China stubbornly refused to do. For China, this was therefore not the moment to abandon North Korea, given that it presented itself as its closest ally. In addition, in 2001, the matter of the 2008 Olympic games was being settled and China was determined to host them. It was therefore important to show that the border was absolutely “watertight” and that there was no immigration problem. The timing was therefore not good for us. Our thinking was that if we continued openly to take public positions, from China, in the name of MSF, we would put the Chinese in an impossible position; they would longer be able to accept it, and would be forced to expel us from China. It so happened that at that time, after three years’ exploratory work, we were in the process of opening an AIDS project at Nanning.

After this long period of negotiation, the authorities in Guangxi province were finally ready to agree to our offering treatment. At the time, the only possible routes for bringing aid to North Korea went through China, but if we were too visible and if we took on too much in the name of MSF China, we risked losing everything. We therefore suggested to Paris that they open a programme in South Korea, from which we could intervene in China. That presented no problem to the Chinese, because it gave them the option of expelling the MSF Korea team without being obliged to do the same with MSF China. Contradictions of that sort did not trouble them at all. At it happened, they allowed us to carry on right up to the point when they felt we were going to far. They then sent us, through intermediaries, clear messages that Marine [Buissonnière, MSF France in South Korea co-Coordinator] and I should stop going to the border. At no time did that endanger danger the French section in China, which was our intention. Another reason that led us to propose switching the mission to Korea was the fact the South Korean networks had become highly developed, and the bulk of the assistance to North Koreans was now coming from South Korea. And then, in the course of our meetings with the refugees, we realised that they were undergoing a long experience of displacement before arriving in South Korea, and that they were all affected psychologically. It was therefore important to monitor them on arrival and to see how they were or were not becoming reintegrated into South Korean society.

Sophie Delaunay, Research officer, Foundation MSF France, June to August 1998; Coordinator, MSF France in China, January 1999 to December 2001; co-Coordinator, MSF France in South Korea, January 2002 to October 2003 (in French).

As of December 2002, the Chinese authorities launched one of its cyclical surges of repression against the North Korean refugees, hunting and forcibly repatriating them by the hundreds. Local aid workers were also arrested and it became increasingly difficult for the aid organisations to give assistance to the refugees.

On 19 January 2003, MSF Seoul issued a press release asking UNHCR to urge the Chinese authorities to release 48 North Korean refugees that had been arrested when trying to leave China for South Korea and three humanitarian workers that were assisting them. On 24 January 2003, Marine Buissonnière delivered a testimony to the Japanese Parliament regarding the plight of the fleeing North Koreans, being victims of a massive campaign of repatriation organised by both the Chinese and the North Korean authorities.

DOCUMENT

“Urgent Appeal for the Protection of North Korean Refugees in China” MSF Press release, Seoul, 19 January 2003 (in English and French).

Extract:

On January 18, 48 North Koreans, including families with children, who were about to leave China by sea and seek asylum either in South Korea or Japan, were arrested by the Chinese security services in Yantai City, Shandong Province. Three aid workers who assisted them were arrested as well. The detained North Koreans, as do thousands of their countrymen, face the risk of being severely interrogated by Chinese security services and forcibly repatriated to North Korea where a grim fate awaits them. As for the three aid workers, they may be subject to long-term imprisonment in China. The case of this group of 48 North Koreans is most revealing: it unveils the distress of the North Korean refugee population in China and the urgent necessity to provide them assistance. It graphically illustrates a human tragedy that will not be solved through repression. The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) can only condemn the arrest of these asylum seekers and denounce the recurring non-observance of the right to flee of asylum seekers and the persecutions they are subjected to.

Within the past three years, China has arrested and forcibly repatriated thousands of North Koreans in flight from their own country in search of asylum and assistance. Since early December 2002, as a way to definitively eliminate the embarrassing question of North Korean refugees, China has launched a new manhunt in collusion with North Korean security services. As of mid-January 2003, 3,200 North Korean civilians in China have already been repatriated as a result of this so-called ‘100 day campaign’. 1,300 others are awaiting their repatriation in the detention centres of Tumen and Longjing. The systematic and organized dragnet taking place in China leaves North Korean refugees no other alternative than a desperate flight to a third country, at the risk of their very lives. The humanitarian aid workers who attempt to rescue North Korean refugees also face the brutal determination of the Chinese authorities, which deem the assistance of North Korean refugees as a criminal offence. In addition to facing jail terms, deportation and fines for assistance, Yanbian residents who are suspected of being humanitarian aid workers are now forced to take a written oath to the effect that they will not provide assistance to North Korean refugees. Bounties for the identification of either humanitarian aid workers or North Koreans remain commonplace. Predictably, in this context, support for North Korean refugees in distress is diminishing and assisting them has become a challenge that increasingly few aid organizations, crushed by this sanction policy, are able to undertake.

As international attention is now turned to Pyongyang’s regime for a separate crisis, the fate of North Korean refugees remains resolutely ignored. Neither China’s repeated violation of international conventions nor desperate attempts by hundreds of North Koreans to seek asylum in foreign representations have resulted in measurable progress on the question of the protection of North Korean refugees in search of asylum. The United Nations High Commissioner for Refugees (UNHCR) in Beijing, approached repeatedly on this matter, has simply been unable to ensure their protection.

MSF earnestly urges the UNHCR to demand from the Chinese authorities access to the North Koreans under arrest and to examine their asylum requests. MSF asks that in accordance with international law, the North Korean detainees not be repatriated and that they be protected. MSF asks that the humanitarian volunteers be freed. MSF vigorously condemns the repression and the forced repatriation of North Koreans in China. It denounces the Chinese measures aimed at criminalising the humanitarian assistance directed to the North Koreans.

DOCUMENT

“MSF Pushes for Rights of Fleeing North Koreans,” Testimony delivered to the Japanese Parliament by Marine Buissonnière, 24 January 2003 (in English).

Extract:

Today, we would like to address three fundamental concerns regarding the disastrous humanitarian situation of North Korean asylum seekers:

1. The lack of protection for North Koreans fleeing their country

2. The criminalisation of humanitarian aid to North Koreans in China, leading to a shrinking space for assistance

3. Lack of political willingness to acknowledge and guarantee the basic rights of North Korean asylum seekers.

The United Nations High Commissioner for Refugees (UNHCR) mandate is to promote the right of refugees and to monitor the implementation of the refugee convention by its state parties, including China. Having been present in China for years, UNHCR has failed to engage in a constructive dialogue with the Chinese government on the status of North Korean asylum seekers. Numerous discussions between MSF and UNHCR about the need for protection have not proven fruitful. The countries involved in the region, including China, Japan, South Korea, the US and the European Union (EU) all share a responsibility in this crisis. MSF approached repeatedly the Chinese authorities to cease forced repatriations and allow humanitarian assistance for the North Korean refugees. These calls have gone unanswered. Field information on the conditions of refugees has also been brought to the attention of EU representatives, European states and the US government. As international attention is now turned to Pyongyang’s dictatorship for a separate crisis, the fate of North Korean refugees remains resolutely ignored. Neither China’s repeated violation of international conventions nor desperate attempts by hundreds of North Koreans to seek asylum with foreign representations have resulted in measurable progress on the question of the protection of North Korean refugees in search of asylum.

What is the responsibility for the countries concerned?

The recent failed asylum bid of the group of 48 North Koreans is most revealing: it unveils the distress of the North Korean refugee population in China and the urgent necessity to provide them assistance. It graphically illustrates a human tragedy that will not be solved through repression. The systematic and organized dragnet on refugees and aid workers, which has intensified in China, leaves North Korean refugees no other alternative than a desperate flight to a third country, at the risk of their very lives.

Médecins Sans Frontières expresses its grave concern over the endless suffering of the North Koreans seeking refuge in China. The refugee crisis will only be solved if there is a clear political will from the countries and institutions involved to protect North Koreans in search of asylum and guarantee their basic rights. In absence of protection, humanitarian assistance is impossible. Countries involved in the region should therefore negotiate practical solutions with China, which would include a secured space for relief and protection. The Japanese society is showing its concern over the North Korean asylum seekers. As a major power in the region, Japan has a duty to exercise its influence for the benefit of North Korean refugees. MSF hopes that the Japanese government will play a leading role in stimulating an international debate on the issue of North Korean refugees and in promoting their protection. Thank you for your attention.

From 27 February to 27 March 2003, the MSF team in South Korea organised a targeted lobbying campaign, visiting several officials of different western nations and those of United Nations agencies. MSF France opened a programme aimed at bringing social and psychological assistance to the North Korean defectors arriving in South Korea at the end of the thousand kilometre journey. The team also carried on giving support or attempting to do so, to different organisations helping North Korean asylum seekers in third countries (Thailand, Russia, Vietnam, Cambodia). www.video.17

DOCUMENT

“Lobbying/Korea Mission,” 27 February 2003 to 27 March 2003, Report from Sophie Delaunay, Marine Buissonnière, MSF South Korea (in English).

Extract:

Rationale and objective

As the situation of North Korean refugees has severely deteriorated over the past few months, MSF and other organisations working with North Korea have had to face a drastic restriction of their space of assistance in China. At this point, it has become virtually impossible to efficiently assist North Korean refugees in flight of their own country as the Chinese hunt them and arrest as criminals, those who provide them assistance. We really feel that the problem is political and that there is not much we can do at our level unless minimum protection for the refugees is ensured. No states have so far taken upon themselves to confront China on the issue, and the UNHCR has remained powerless in initiating a constructive dialogue with the Chinese authorities. Pushed to extremities by the situation in China on the issue, we resolve to increase our lobbying efforts and use the pre-Iraqi war window to try to bring forward once more the issue of North Korean refugees and put politicians in front of their responsibilities.

[…] Conclusion: where do we go from here?

It is difficult to precisely measure the impact of our lobbying efforts. However, a few signs clearly show that the pressure put by various organizations and activists in the past few months has not been completely in vain:

- At the UNHCR level, it seems that they are considering for the first time the TPS option for North Korean refugees

- At the French government level, it seems that the French MoFA [Ministry of Foreign Affairs] (Villepin) was very vocal at the UN Human Rights Commission: “it is high time that the Commission looks into the situation in North Korea, where an entire population is suffering in oblivion and silence.” Villepin urged the UN Commission to focus on North Korea. EU member states altogether denounced the North Korean Human Rights abuses.

- At Parliament levels, it seems that a few MPs are willing to gather energy from various countries to bring in similar resolutions in front of various countries’ parliaments (Japan, US, UK…) […]

DOCUMENT

“MSF International Activity Report 2003,” (in English and French).

Extract:

MSF continues to condemn China’s forced repatriation of North Koreans and repression of humanitarian aid workers assisting them. It urges the United Nations High Commissioner for Refugees to demand access to North Koreans held by China and to examine their asylum requests. Active in North Korea from 1995 to 1998, MSF withdrew due to a lack of access to people in need and no independence to carry out its programs. Nonetheless, MSF continues to assist North Koreans. In 2002, MSF provided food and medical aid to around 900 people: shelter, clothing and food for those in hiding along the Chinese border; help with resettlement and medical care for some who made it to South Korea; medical care upon request in China and third countries; and assistance to several families and occasional aid supply in North Korea itself. MSF also collects refugees’ accounts to raise awareness of their situation in the media and with governments, UN agencies, and human rights organizations.

MSF Holland carried out a ‘North Korea research Explo’ in order to evaluate the feasibility of a new MSF mission inside North Korea. In October 2003, the MSF book “In the Shadows of Just Wars” was published. One of the chapters, written by Fiona Terry, was dedicated to the North Korea. It was titled: “North Korea: Feeding Totalitarianism”.

DOCUMENT

”North Korea Research Explo – Report Draft 3 - July 2003,” Tim Pitt, MSF Holland, July 2003 (in English).

Extract:

Introduction

This report has been motivated primarily by an impression gained from the public media prior to October 2002 that the leadership in North Korea may have changed or is changing its regard for the outside world. It has also been recognised within the MSF H Amsterdam HQ while North Korea remains a significant humanitarian crisis in which one should be at least fully informed if not operationally active, that a generation had past in the office of those who dealt directly with the aborted mission in 1997-1998 and no one had any direct insight into this unusual country. With both these points in mind, a research explo was deemed worthwhile to examine, again, if a MSF mission may be feasible inside North Korea. Since the international mission of MSF stopped activities and withdrew from operations in September 1998, there has been no substantial effort to pursue renewed operations inside North Korea. This has been mainly due the lack of respect by the North Korean regime for standard humanitarian operating principles.

The offended principles of humanitarian action which prompted the departure of MSF from North Korea were: little or no basic information on health infrastructure and population numbers, zero direct access to beneficiaries and no capacity for benchmarks, monitoring and evaluation. As such, a proper humanitarian mission to answer morbidity and mortality was not possible. And so the question that lies at the heart of this research explo: has operational humanitarian environment changed in a meaningful way such that a MSF mission is feasible?

To that end, this research explo’s objectives are:

1. To review and summarise the situation that led to the MSF withdrawal from DPRK in 1998.

2. To make an inventory of the organisations currently working inside DPRK and consider the constraints upon their operationality.

3. To establish a plan to approach the Go [government] DPRK for possible in-country explo/ intervention.

Recommendations and annexes will follow each objective taken in turn. […]

CHAPTER 3 […]

Has operational humanitarian environment in North Korea changed in a meaningful way such that a MSF mission is feasible?

- The short and simple answer is no.

- However, if one is to change the premise of the question, the answer may be yes.

Firstly to review why the short and simple answer is no.

Since the departure of MSF in 1998 the Go [government of] DPRK has not permitted freedom of movement, not allowed independent assessments; in the main, has not permitted contact with ordinary North Koreans or beneficiaries (with the exception of ICRC who necessarily meet the people who require prosthetics) and has not permitted agencies to evaluate their programmes. From this one can see that standard humanitarian programmes with measurable humanitarian objectives are not possible. One may bear in mind at this point that this is especially so for an organisation like MSF which highly prizes the direct contact between patient and doctor, diagnosis and follow up. Nonetheless, agencies that pursue other programmes which structurally or ethically do not necessitate such intimacy with the local populations, while sympathetic to MSF concerns, seem to have less of a moral problem with their own work in North Korea. Agricultural reform, Food delivery, developmental projects that target infrastructure are programmes that seem to have a less bumpy road. Indeed, within the Juche ideology, humanitarian assistance is difficult to reconcile while developmental assistance is easier to hide from the local population and also propaganda-wise easier to explain.

And so secondarily, if we are to adjust the premise of the question, there may be an affirmative answer to the core question.

To find an answer yes, one would need to accept that the real objective of a programme was outside the normal measurement of success for a MSF programme. In one sense the required shift may be away from humanitarian objectives, where the MSF doctor would relieve directly the suffering of a particular group or individual. The recalibrated objective would have to be more developmental more.

What kind of programme?

- Medical equipment distribution

-Training (although packaged in a more ‘orientation’/refresher course fashion)

One can look upon such a programme pragmatically in the following way.

1. Firstly material from a distribution programme may actually help an under-resourced and antiquated health system provide some benefit for the North Korean people. Not even the harshest critics of the North Korean regime would argue that all the medical staff are corrupt in their treatment of their patients. In such a programme MSF would have to design a distribution list of items that would have minimal opportunity for misapplication given the poor quality of medical education and that MSF would not be able to follow the items in implementation. There are precedents for this kind of programme in MSF though admittedly these were in locations where more of course was known about the health system and the level of competence of the people who would utilise the material. Likely the level of sophistication of material for distribution in North Korea would be very low in order to be comfortable for MSF. This could be a deal-breaking point for the North Koreans. Further consideration of this point with medical staff is required.

2. Secondly, one can pragmatically note that such a programme would afford a presence in North Korea, which would at least give the possibility of further (recognisably very limited) investigation of the health and humanitarian circumstances. Bearing in mind that other organisations have found unexpected opportunities for conversations and anecdotal insight, a distribution programme if partnered with the MoPH and supported in part by the WHO, would necessitate contact amongst medical professionals and afford opportunity to ask medical questions, of some sort.

3. In such contacts, and even in contact with FDRC representatives, a kind of témoignage could take place in the form of politely but sharply phrased questions. Rather than simply making statements about how bad a practice is, once could pose Socratic questions that have the North Koreans come to understand that there is another way. For example: Does x appear to be a problem? Why not? What do you do if y and z happen? Should we think about this more? This kind of engagement may afford further opportunities. However one must recognise that it may take years to achieve dialogue and to get answers and to move forward on identified problems. This kind of témoignage may be of greater value and effect for North Koreans than the current tone taken with MSF’s articles of outrage and testimonials that one currently finds on the web.

How to approach this?

Firstly one will want to examine the MSF H Burma example …One should explore if the early years of effort in Burma has instructive lessons for what could be a similar effort in North Korea. Then important and very real questions in Amsterdam HQ need to be answered and all in the affirmative.

“Internal questions”

More immediately and bearing in mind the 1998 lessons learned as well as the more recent lessons learned …

1. Can MSF H get MSF F on line? And Can MSF H get MSF F to keep quiet for the duration of a new effort?

2. Human resources: Likely not an expat intensive programme but can Amsterdam identify an experienced medical line manager, preferably someone well above the average MSF age who has a sharp political antenna and good negotiation skills?

3. Amsterdam: Can Amsterdam allow a long-term time line before judgement on success or failure?

!! Each of these is a killer pre-condition. If any one of these is not feasible, then the effort should not move forward!!

“External questions”

- Would the most important donor be interested to support MSF? To approach ECHO, ideally Paul Filler. Sort out if as a donor would be interested to fund a distribution programme, stimulate the govt to invite us to meet and discuss “programmes.”

- Would the United Nations be interested to support MSF? Then approach WHO/OCHA rep of Pyonyang and Geneva to discuss their impressions and reaction to such a programme and most importantly to gain insight on how to achieve the Ministry of Public Health as a counter part; specifically how to avoid the FDRC as a counter part. Then to approach the UN Special Envoy in New York or Geneva who would speak informally on our behalf. Possibly to simultaneously circulate rumours through Concern or SCF in North Korea on our behalf. Possibly to approach 2 NK embassies in Europe to express formally our desire to meet officials (2 embassies by the same people so that Pyongyang gets the same message twice) although this may be over doing it …

DOCUMENT

Chapter II –1 “North Korea: Feeding Totalitarianism,” by Fiona Terry in “In the Shadows of Just Wars,” edited by Fabrice Weissman, MSF – C.Hurst & Co Publishers Ltd, October 2003 (in English).

Extract:

Half a century since an armistice ended the Korean War (1950-53), the Korean Peninsula remains the site of the last Cold War confrontation. Some 37,000 American troops are stationed in South Korea to deter any new attempt to reunify the Peninsula by force, and North Korea keeps its 1.1 million strong army permanently mobilised against the ‘imperialist aggressors’. The citizens of North Korea, the last bastion of Stalinism on the planet, are among the world’s most deprived and oppressed peoples, lacking even the most basic freedoms in a country controlled by the grotesque personality cult of its dead yet eternal leader, Kim Il Sung and his son, Kim Jong-il. Between 150,000 and 200,000 people are believed to be languishing in North Korea’s gulag for having committed a ‘state crime’, which any act of defiance or disrespect, however small, can be labelled. Over the last decade, famine has exacerbated the suffering of the North Korean people. North Korean refugees in China suggest that up to three million of their compatriots died from starvation and related illness between 1995 and 1998 alone. Aid organisations responded to the crisis, but reached the limits of humanitarian action in this totalitarian state. North Koreans continue to suffer and to die in spite of the largest food aid program in the UN’s history.

From 18 to 22 May 2004, Michiel Hofman and Dick Van der Tak, from MSF Holland, visited DPRK. The invitation had been negotiated through the DPRK embassy in Bern, Switzerland. The objective of the visit was to negotiate a further MSF medical assessment in the country. The conditions for this visit were discussed with all the people interested in the issue within the MSF movement.

DOCUMENT

‘Trip report - Democratic People’s Republic of Korea,’ Michiel Hofman, Dick Van der Tak, 18 – 22 May 2004 (in English).

Extract:

Objectives of the visit

The main purpose of the visit was to negotiate terms & conditions for an MSF medical assessment In North Korea. Before the trip a brainstorm session was held in Amsterdam with all interested parties inside MSF, including desks for North Korea programmes from Paris (Gaelle) and the Previous Head of Mission for the North Korea programme (Marine) to determine what the ‘bottom line’ was for MSF on conditions for this explo:

Non-negotiable:

•The definition of a (possible) programme is based on the needs assessment;

•Access to patients and expats involved in diagnosis & treatment;

•We will listen to Govt. recommendations for areas of intervention, but will also make our own suggestions;

•We will not bring a major donation – we work needs based only

•We choose the composition of the explo team.

Highly beneficial:

•Bring our own translator;

•Changes in itinerary possible;

•Horizontal or vertical programmes;

•Cross borders in North Korea;

•MoH involvement;

The invitation to visit DPRK for discussions with the Ministry of Health and FDRC were negotiated through the official channels of the DPRK Embassy in Bern, who also holds the diplomatic representation to the Netherlands. Medical donations of any kind were not part of this visit. […]

Conclusions

A clear effort was made during this visit to appear as ‘flexible’ as possible – allowing changes in the pre-set programme, allowing pick-and-choose drop-ins in the patients wards. As this experience was not echoed by the other two organisations that were making an assessment trip at the same time, which faced obstruction and inflexibility, it remains to be seen what the reality will be during the assessment. It is possible that:

-DPRK officials are always ‘nice’ on the first visit, and become nasty as soon as you have your small toe inside the door.

-The theory about the influence of liaison officers is correct, and we were just lucky with ‘our’ minder.

-There is some hidden reason why they are particularly eager for MSF to re-engage with DPRK, so we get more leeway.

In spite of doubts if our experiences with access to patients and flexibility of choosing your own areas of intervention is a real indication of change, there is enough secondary evidence of other actors (WFP, SCF-UK, ECHO, Merlin) that some sort of ‘Glasnost’ has occurred in the past year with regard to humanitarian assistance, allowing more freedom of movement, access to beneficiaries and choice of intervention areas to justify an MSF assessment mission. This mission needs to have a certain level of ‘give and take’ to make it work, without loosing sight of the minimal conditions for MSF to work – hence the suggestion to assess one of the Government suggested provinces balanced with two proposed by MSF – and this logic needs to extend to the micro-level during the actual assessment as well.

DOCUMENT

Comments on the Trip Report by Marine Buissonnière, MSF International General Secretary, July 2004 (in English).

Extract:

Comments on the conclusions:

I believe that an additional explanation to the apparent flexibility of DPRK counterparts may come from the fact that MSF did not ask anything outrageous, only asking to go to areas/hospitals where they had no problems for us to go – and where we had worked in the past. DPRK officials are ‘nice’ as you say, but they have constraints and a very clear understanding of where one should go or not go, ask or should not ask. So I guess it is premature at this stage to come to the conclusion that we have demonstrated our ability to reach the places where the most vulnerable are – but it is certainly worth trying! In that spirit, I perfectly understand that any explo would be a give and take process, but I also would like to re-emphasise that we should put all the chances on our side and that in this context the importance of choices of geographic location, nature of institutions accessed, and presence of MSF’s own Korean translators would be central. If I am convinced that it is worth giving it a try, I am also convinced that for North Korea more than any other place, the challenge is not to go back in per se, but what you can do once you are there, where it is so easy to be manipulated into caring for those that the system considers worthy, and not for those who need it the most.

INTERVIEW

In Amsterdam, there was no debate like: ‘was the decision to leave North Korea the wrong decision?’ Everybody understood and accepted that it was impossible to continue under those circumstances. Generally speaking, there was no feeling of having to mend what was wrong. But conversations continued to simmer: ‘what about North Korea?” People kept aware that there were needs, people changed, time passed on. Then there would be different people, different opportunities to look into the options for MSF to go back and work under acceptable circumstances. To keep it simple, our first objective was to shake hands and first of all mend fences, and also test the borders. We had no clue on what to expect when coming back. The second objective was to negotiate a longer exploratory mission. It was very clear that in 4-5 days in North Korea it is impossible to do anything meaningful. And also, considering everything, it would have been overly ambitious to think that we could immediately start a project. So the objective what to negotiate a two-three months longer exploratory mission so that we could put people for longer on the ground to make a proper assessment of the need and also assess the working conditions in North Korea.

To be honest, I don’t know why we were invited back. They know very well MSF’s position. In the negotiations before the assessment, the exit in 1998 came up. There was a request that it should be MSF H who had distanced themselves from the position in 1998. The answer was: ‘no, we are one movement, this is what we did and you’ll have to deal with it as an organisation, our views have not changed.’ That was very clear, clearly communicated. Still they accepted the visit. In my simple thinking, there must have been a reason why they invited us back. They didn’t invite us for tea. And I have to say the visit was quite nice. You have to be prepared to be bullied a bit and lectured about the superiority of the North Korean system, and how these rubbish NGOs are all American spies, etc. It didn’t happen at all, as I said. They let us look around; they accepted the changes in our itinerary. So, I don’t understand. Still I think we must have done something wrong since they slammed the door again. But I don’t know what it is. I’m clueless; I have no idea.

Basically the conclusion is that nobody has a clue. Not everybody agreed to MSF going back to North Korea. There was particular concerns especially in Paris about, ‘is the time right? What conditions MSF Holland is willing to accept? Etc.’ So the proposal was also discussed in the international movement and one of the proposals was to put either Marine [Buissonnière] MSF International General Secretary] or Rowan [Gillies, MSF International President] in the assessment team. I’m not sure they put Marine and maybe if Marine’s name is put in a computer in North Korea all red buttons will start beeping, the machines start smoking!

Dick van der Tak, Coordinator MSF Holland in China, January 1999 to May 2000; MSF Holland HAD adviser, July 2000 to June 2003; MSF Hong Kong Executive Director from 2003 on (in english).

INTERVIEW

The visit by MSF Holland in 2004 was entirely official. I believe they went to the North Korean representation in Switzerland to obtain visas and to do a tour over there. In no way at all were they mandated by MSF’s international office. Later, that became a point of dispute and it was a matter of sending an exploratory monitoring mission, which should really be the subject of an international approach, since I was on the list to go there [at the time Marine was General Secretary of MSF’s international office] if it had been possible to go back. But to the best of my knowledge, there were no further developments. I am not surprised. Médecins du Monde was in the same situation. We know what interests the North Korean authorities; in the end it is to obtain resources, large volumes of aid with minimal control. It is clear that an approach at the human level, which Biberson wished to see in the mid-1990s, involving direct intervention with the populations concerned, is something that in my opinion is not about to be accepted by the central government. It’s difficult for me to imagine it.

Marine Buissonnière, Secretary General of MSF International, 2004 to 2007 (in French).

In January 2006, MSF France closed its programme in South Korea.

DOCUMENT

‘MSF International Activity Report 2006,’ (in English - in French).

Extract:

The present conditions in North Korea make it impossible to provide independent and impartial humanitarian assistance directly inside the country and reach those that need it most. In 2005/2006, MSF provided care to North Korean refugees through projects operating out of South Korea. In Seoul, MSF has been the only foreign organisation present in the transit governmental centre of Hanawon, where North Korean refugees are placed for their first three months upon arrival in the country. MSF has developed mental healthcare activities in Hanawon to help refugees cope with symptoms of trauma - over 200 patients received MSF psychological support in 2005. Following strong lobbying by MSF, positive measures have been undertaken by South Korean authorities to provide much-needed psychological support for North Koreans both within and after they leave the transit centre. In April 2006, 150 mental health professionals attended a conference mounted in collaboration with the University of Psychiatry, Seoul, to discuss therapeutic approaches to care and review the three years of the MSF mental health project. Responsibility for the provision of psychological assistance to refugees was then handed over to local authorities.

INTERVIEW

We could tell ourselves stories, but the real periods of famine and death in North Korea, which were linked with the lack of food distribution to certain groups, were the years from 1995 to 1998. Later, North Korea was the country receiving the largest quantities of food in the world. We were no longer faced with the humanitarian dilemma of an organisation trying to provide aid. It was no longer the same thing. The North Korean system had protected itself; it had succeeded in breaking up the escape networks that had been established – the whole system around the embassies, and so on. We may look critically at the way MSF may have played a part in that, and perhaps also allowed networks to be identified without realising it. We must simply agree to tell ourselves that things change. In this case, it was up to a human rights organisation to go and try to gather personal testimonies. But it was no longer a question of providing assistance. Otherwise, we choose to help to reconstruct the system. But there are already NGOs over there, funded by the European Union, who are trying to bring about an increase in local production

Pierre Salignon, MSF France programme manager, from October 1997 on, then MSF France Executive Director from January 2004 on

INTERVIEW

My cause for regret is the poor way in which we integrated this mission into MSF’s wider structure. The fact that Marine and I had personal responsibility for this project, and that we were personally supported by Pierre [Salignon, programme manager, then Executive Director] and Jean-Hervé [Bradol, President] enabled us to move very fast, without being held back. But in another respect this had a rather harmful effect on communication around the project. It coloured the way the team leading it was perceived, and affected opportunities for the French section, and for the MSF movement to take ownership of it. The situation was complicated because we could not say in public that we were working with refugees – we had to be careful about informers. But internally, inside MSF, we should certainly have shown greater skill in persuading the operations department to “own” the mission, so that it did not remain exclusively Pierre and Jean-Hervé’s baby. They gave us carte blanche, but after other volunteers had taken over, they did not support them as much as they had supported us. Other sections were also annoyed. We must have looked like a pair of conspirators. We should have held briefing meetings, suggested “Korea days,” and published articles. It is for those reasons that I ceased work in 2003; because I said to myself that if we wanted to give this project a chance, it was time to go, and to let somebody else take over.

Sophie Delaunay, Research officer, Foundation MSF France, June to August 1998; Coordinator, MSF France in China, January 1999 to December 2001; co-Coordinator, MSF France in South Korea, January 2002 to October 2003.

In March 2007, Marine Buissonnière and Jean-Fabrice Pietri, ex-ACF responsible for North Korea carried out an exploratory mission in Far East Asia for MSF Switzerland and looked into the possibilities of developing cross-border assistance operations inside North Korea and/or to North Korean refugees.

DOCUMENT

‘North Korea: Can we help ?’ article by Marine Buissonnière, published in TAG, Internal Journal of MSF Switzerland, August 2007 (in French).

Extract:

Mr Lee is aged 45, but he could easily be taken for 15 years older. We met him in a large city in northeastern China, where he had been living in hiding for several years. Despite the daily risk of being reported and arrested by the Chinese police or North Korean agents, he could not bring himself to leave the border zone. He had left his daughter in North Korea, and if he attempted the dangerous journey to a third country, he would have to resign himself to abandoning her forever. He was a war orphan, a former bodyguard of Kim Il Sung, and fled his country after opposing the central government with violence in summer 1996 – that bloody summer when he had had to bury a third of the citizens in the village for which he was responsible. And while the signs of the famine in 2007 may seem to recall those of 1996, Mr Lee underlines a fundamental difference: the survivors know first-hand the horror of famine, and are not prepared to re-live it. Discontent appears to be increasing in Korea’s northern provinces, where the prospect of new periods of food-shortages, combined with outbreaks of measles and cholera, is driving those living near the border to make desperate pleas for help. Appeals for food aid are increasing on the part of North Koreans who have come to beg illegally in China for the aid they will never receive from the central government, which long since chose to sacrifice them for the survival of the regime of Kim Jong Il.

There are dozens of Mr Lees hiding in China, often with the assistance of clandestine aid networks, mainly of a religious nature, who try, with their slender resources, to offer them food and shelter. Some have come to look for a means of subsistence and have not wished, or not been able, to return. Others have fled imprisonment, or even a death sentence. Unscrupulous brokers, providing brides in rural areas and supplying the sex industry, have sold women at the border. Children are born of these unions, ‘bastards’, with Chinese fathers and North Korean mothers, but nobody takes care of them once their mothers have been forcibly sent back to Korea. The number of North Koreans in China is currently estimated at 400,000, half of them in the border zone. China considers them illegal economic migrants, and during the run-up to the Olympics, is constantly arresting them and those who assist them, and sending them back to the North, where for a few months they will join the 1.2 million people held in the North Korean prison system. Nevertheless, no matter what measures China and North Korea take to stop them escaping (encouragement and rewards for informing, intensified checks, rapid rotation of officials on guard-duty, use of dogs by border patrols, and so on), the refugees continue to cross the border. Information about ways of getting out is more widely available than ever in North Korea, and for every refugee who succeeds at the risk of his life, there is a whole family waiting to follow him.

So the question for MSF is, what appropriate help can be given to this suffering people, whose medical, public health and nutritional needs are enormous, both inside country and among those who have succeeded in escaping it? For my part, it seems to me as long as official international assistance in the DPRK is channelled by the government, which chooses the ‘beneficiaries’ of aid according to criteria of social usefulness and political loyalty, any programme inside the country will be inconceivable. In fact, the organisation of the regime, based on an Orwellian class system, also determines the right to assistance. Those who belong to the class of the ‘faithful’ (11% of the population) can dream of living in Pyongyang, being given priority in the system of public food distribution, and of sending their children to university. Anyone else, who belongs to the “hostile” class (27%), will be condemned to the life of a convict miner in the northeast, and to finding the means of subsistence for himself. A curse on anyone whose ancestors were landowners, or whose mother did not weep with sufficient conviction over the death of Kim Il-Sung!

The tonnes of food and of medicines supplied to North Korea by the international community from the mid-1990s onwards were channelled through the central government and were naturally distributed on the pattern that had always prevailed: loyal elements (central authorities, party cadres, the army, workers in key industries) received priority, then supplies were stored to support the war effort, and finally a miserable amount was distributed to the rest of the population on national holidays. Access to health services works on the same principles; medicines are reserved exclusively for the privileged class, while the rest have to be content with fakes, or with scraps of international aid re-sold on the black market at exorbitant prices by the wives of officials.

Armed with the results of detailed research carried out among North Korean refugees, and after three years spent trying to develop an appropriate programme of assistance, MSF left North Korea in 1998, convinced not only that its help was not reaching the most vulnerable, but that it was helping to prop up the regime that was oppressing them. Given the extreme bias in the selection of beneficiaries, the impossibility of measuring needs or targeting the most vulnerable, the lack of transparency in distribution, the total control or deception over access to beneficiaries, and the impossibility of measuring the impact of aid; rarely had there been a situation in which there was less room for humanitarian action, or greater manipulation to a regime’s benefit. But at the same time, rarely could the needs of the majority of North Koreans – living in conditions of terror that only the strongest manage to survive, and for whom daily life is an unremitting struggle – have been more clearly visible.

After some years, following the exploratory visit we have just made to northeast Asia (Korea, Japan and China), our analysis of the situation has not, in my view, fundamentally changed. The regime is still propped up by the unconditional support of the ‘faithful’ who benefit from the system, their ranks closed around Kim Jong Il in Pyongyang. Recently forced into a corner by sanctions and the repercussions of testing its nuclear missiles, the government is trying – and will certainly succeed once again – to use the bogeyman of the nuclear threat, and by renewing its fears, to extract donations of food and energy from the international community. As early as mid-March 2007, Kim Jong Il was crowing over acknowledgement of North Korean superiority by the western powers, which would soon flood North Korea with foodstuffs. It is thus still possible for humanitarian organisations to buy their way in via the central government, and to develop aid operations oriented towards sections of the population that the North Korean government has selected for their social usefulness and political loyalty. Some have made that choice, believing that it will be possible for them gradually to open up an adequate space in which to work inside the country. Others (like the UN, for a long time) have put their money on “fungibility”: the more aid there is, the more likely it is that in the end resources will reach the most vulnerable.

From MSF’s perspective, that option does not seem to me to meet the criteria for properly impartial aid. There remains, then, the possibility (and to my mind, the responsibility) for an organisation like ours:

-To explore the opportunities for assistance inside North Korea that would by-pass the central government (e.g., cross-border aid to provinces on the frontier). With Chinese businessmen trading with the North, and the right to family visits by ethnically Chinese Koreans, real options exist for bringing assistance from China to villages in border provinces. In the coming critical months MSF should follow closely how the food situation develops, and it should be in a position to seize the opportunities that could arise if the situation deteriorated.

-To envisage setting up a programme of first aid (food and shelter) and of medical aid in China and the countries of South-East Asia, serving people who have succeeded in escaping the regime. Such work can be envisaged only in close collaboration with local aid networks who are assisting these people, and who need medical support from MSF.

Such operations, aimed at people in North Korea, require long-term investment, and a clear-minded and reasoned choice of operations that are discreet, flexible and highly responsive. Working in close collaboration with the networks, which are the means of entry into this thorny area, also requires the building of mutual confidence, without which MSF cannot gain access to people living clandestinely. It is therefore a complex operation, and an unorthodox one for an organisation like ours. But at a time when it is difficult to fit a regime like that of North Korea into our standard typology of crises, it seems more important than ever to remain involved and to try to bring assistance to the victims of a totalitarian system whose ferocity passes all understanding. It is right that MSF is remaining in Iraq, continuing its efforts in Chechnya and taking a renewed interest in Afghanistan. Is it not also time for us to concern ourselves again, in the Far East, with the fate of the most vulnerable sections of the population living under the implacable regime of Kim Jong Il?

INTERVIEW

One element of this exploratory mission – I was genuinely open-minded towards it – was to try to understand whether or not there was a space that we could occupy inside the country, and whether that had changed. After my visit in April 2007, I take a position similar to that of the mid and late 1990s. Today we are facing a regime that relies on a class system, combined with terror, a system of repression and informing on others. In contrast with those opened up by China in the 1980s, under Deng Xiaoping, the special economic zones that this regime is beginning to establish are completely closed and controlled, and serve only to generate income; their sole aim is to reopen [the flow of dollars] to a country whose national economy is at rock bottom. Kim Jong-Il, surrounded by a clique of generals and leaders of the army and the Korean Workers’ Party who manage to live by operating in “mafias,” cannot, in my opinion, allow himself to slacken his grip and open up any further, or he risks losing power. I have no faith that the situation will gradually evolve. The few people who know North Korea well, such as Jasper Becker and others, have come to the same conclusion: even if currently there is dissatisfaction inside the country, especially in the northern provinces, the system’s ability to resist [change] and its behaviour are such that the key is the army, and as long as the army lives by the system, nothing will change.

Marine Buissonnière, MSF Switzerland exploratory mission around North Korea, March-April 2007 (in French) interviewed in 2007.

INTERVIEW

I was always very supportive of MSF France‘s activities in relation to North Korea, because it’s something that MSF could do. And I think that maybe someday the regime in North Korea will have collapsed and we will have to answer questions: ‘what did MSF do for the North Korean people?’ And we need to have answers to these questions and be able to say that at least we tried.

Dik van ver Tak, Coordinator MSF Holland in China, January 1999 to May 2000; MSF Holland HAD adviser, July 2000 to June 2003; MSF Hong Kong Executive Director from 2003 on interviewed in 2007.

INTERVIEW

With hindsight, I believe that MSF’s speaking out in 1998 was justified and pertinent. My conscience would have been less clear had we done nothing, rather than take this position, which was a courageous one. We paid a high price for it in humanitarian circles, above all in our subsequent inability to provide assistance to North Koreans at the very time when we were certain that they needed it. This was the hardest thing for me, and I still don’t have the solution. Later, we did in fact provide assistance to several hundred North Korean refugees, but the problem is still there today, and it requires a quite disproportionate expenditure of energy to reach these people and to support them in the way they need. I regret the fact that we did not find a second route, an operational alternative, and that we did not go further forward in the direction in which we started, an initiative involving networks that had to be innovative. I see the problem of North Korea as being very similar to that of Chechnya. In terms of North Korea, we should have made greater efforts to identify local actors on whom we could have relied. We did not succeed in North Korea because the only local actors were Chinese, and in China nobody would have taken the risk of going against party policy, it was too great a risk.

We knew that our operational impact was limited and that it could come to an end overnight. When you are working clandestinely, you cannot take the risk of putting people or organisations in danger. We were extremely careful, and we were ready to take the decision to close a shelter at very short notice. We wanted to maintain a link with these people, to be an observation post, to continue to monitor what was happening inside the country, so that we could react, document, continue to speak about it. That is what distressed me, seeing that the networks were not being kept alive. We were working on a ridiculously small operational scale in comparison with what MSF is doing today [in other programmes]: 100,000, euros which is nothing. At the same time, it demanded a tremendous expenditure of energy on our part, but at least we had constant information about events inside the country. I am very pleased that MSF Switzerland wishes to carry on the work. It’s like Chechnya, or Afghanistan; you have to preserve contact. You don’t have to bring out the big guns or set up a huge programme, you can just keep watch.

Sophie Delaunay, Research officer, Foundation MSF France, June to August 1998; Coordinator, MSF France in China, January 1999 to December 2001; co-Coordinator, MSF France in South Korea, January 2002 to October 2003 interviewed in 2007.

2. There are over 35,000 US troops in South Korea today.

3. He was appointed as Chairman of the National Commission of Defence of DPRK and the Supreme Commander of the Korean Peoples’ Army.

4. A European network of NGO dedicated to provide services regarding food aid.

5. “1998 – Famine en Corée du Nord : Un peuple meurt” Jasper Becker, ’l’esprit frappeur’ France.

6. See “Hunting and killings of Rwandan refugees in Zaïre-Congo 1996-1997” Laurence Binet – Médecins Sans Frontières (August 2004).

7. IDA Foundation is an independent not-for-profit organization, established in 1972 in Amsterdam by a group of pharmacists committed to contribute towards greater accessibility of healthcare supplies in developing countries.

8. Actually, from the beginning, the MSF team had difficulties to work with the Buddhist organisations and coordinated mainly with the Protestant network. Thus, the refugees they interviewed were not the same as those interviewed by the Buddhists.

9. See “Hunting and Killings of Rwandan Refugees in Zaïre-Congo 1996-1997,” Laurence Binet – Médecins Sans Frontières (August 2004).

10. The English version (translated from French) of the entire document is posted on the MSF USA website : http://www.doctorswithoutborders.org/

11. François Jean passed away in December 1999.