Confronted with the impossibility of carrying
out an assistance programme for the most vulnerable suffering from malnutrition,
the international organisation Action Against Hunger has decided to withdraw
from North Korea.
This has been an extremely difficult decision to take, as Action Against Hunger is convinced that the majority of the country's population is still having extreme difficulties in finding sufficient food for themselves and their families.
Since January 1998 when its programmes began in North Korea, Action Against Hunger's teams have constantly struggled for access to the most deprived in order to ensure that at least a basic minimum assistance reaches them.
Over the past two years, the organisation has provided nutritional assistance to nurseries in the province of North Hamgyong (in the far north of the country), which takes children under five years old.
In these nurseries, our teams have not seen serious malnutrition, yet a community nutritional survey carried out in October 1998 over the whole country showed that 15% of children were suffering from malnutrition. It is evident that these malnourished children do not go to nurseries and are likely to die without any assistance.
In October 1999 in response to this observation, Action Against Hunger proposed a programme of soup-kitchens in the province of North Hamgyong (in the far north of the country) to the North Korean authorities, in order to provide assistance to the most deprived people, particularly street children, whom our teams have often seen in alarming conditions in the streets of Chongjin, the capital of the province.
Unfortunately, the North Korean authorities did not accept Action Against Hunger's normal standards of supervision and monitoring for such a programme. Therefore, the organisation opted to leave North Korea rather than implementing a programme where these very basic principles of humanitarian intervention could not be observed.
Action Against Hunger can only deplore this lack of access to the most vulnerable, who continue to die from malnutrition in spite of the massive food aid brought to the country by the international community.
North Korea Food Security Report
In January 1998 the first team of Action against Hunger leaving for the Democratic People's Republic of Korea knew that it would find an exhausted country:
- Analysis carried out by experts showed that the economic collapse of the country started at the beginning of the 90's
- Surveys and evaluations - inevitably approximate in a regime where opacity is the norm - revealed this economic collapse has had dramatic consequences for the majority of the population and some surveys reported large-scale famine.
"Every day we see dirty children, with unkempt hair, thin and clothed in rags. They are sometimes very young, between 3 and 4 years old, alone and visibly very weak."
A population struggling for survival
"Koreans walk along the roads, bent beneath loads of wood. Sometimes they rest there, even sleep there. The people's everyday life is the search for food, picking roots or plants and gathering wood to warm themselves during winter."
"Roads are full of potholes, rough. Furthermore they are very seldom used by cars due to the lack of fuel. The few lorries we have seen run on wood and corn cobs. To go from Pyongyang, the capital, to Chongjin, distant of 800 kilometres, takes 3 days."
Lack of water and electricity
"In town, electricity cuts are frequent. Public transport, tramways and trolley buses, are often interrupted and the Koreans wait along the pavements in long queues. The supply of water is also subject to interruptions several times a day...Water which is anyway unfit for human consumption."
Abandoned industrial town
"Chongjin, the capital of the province of North Hamgyong, is an immense industrial town, covering several kilometres. But the factories seem to be closed or just ticking over. One rarely sees smoke coming from the chimneys. How does the population survive in such a town?"
I. The need for humanitarian assistance
1. A country going adrift
1-1 An economy in a state of collapse
Since the beginning of the 90's, the country's economy has been going through a dramatic economic crisis. The North Korean economy was founded, until the end of the 80's, on privileged commercial relationships within the communist block, and especially with the USSR and China, allowing imports at very preferential rates, particularly soviet petrol and technology.
The break-down of the Soviet Union and China's economic turn have completely changed this arrangement and plunged the Korean economy into a very serious energy crisis.
The productivity of Korean agriculture, highly dependent on machines and fertilisers, has rapidly fallen.
1-2 The Korean government's call for help in 1995 reveals a country bled dry
In 1995 the North Korean government launched a call for international help, giving as a pretext that serious floods had caused a severe food shortage. However even though the country had suffered a natural disaster that year and then a series of them over the next 3 years, all the observers agree that they only aggravated a food shortage. This shortage in fact dated from the beginning of the 90's, at a time when agricultural production was no longer able to supply the needs of the population. The floods in 1995 merely highlighted the structural bankruptcy of North Korea that the government has not, since then, been able to hide.
At present the GDP of North Korea continues to decrease. The damages are such that the systems of production are largely beyond redemption.
The persistence of a critical nutritional situation in spite of massive food aid
Since 1995 North Korea has benefited from massive international assistance. In 1999, a major part of the country's food deficit has been covered, particularly by the contributions of the UN's World Food Programme, assistance to North Korea being one of its most important programmes.
In spite of this, malnutrition does not seem to have decreased. A nutritional survey carried out in September 1998 by the World Food Programme, UNICEF and the European Union shows that nearly 16% of children still suffer from malnutrition, one of the highest rates in Asia. In addition harrowing accounts collected along the Chinese frontier from North Koreans fleeing the famine reinforce the belief that many sectors of the population are in an extremely worrying nutritional condition.
As in other countries however, the "famine" situation is not caused simply by there not being enough food, but more to the fact that certain categories of the population do not have access to it.
In this context, when Action against Hunger decided to intervene in North Korea, it fixed two targets:
- To find a way of ensuring access to assistance for victims of hunger
- To gain an better understanding of the North Korean environment, so as to implement increasingly relevant programmes.
From January 1998 Action against Hunger has essentially focussed its programme in the province of North Hamgyong, a region situated in the extreme north of the country that has particularly suffered from the depressed economy. The aim has been to implement a programme to prevent malnutrition in the nurseries and kindergartens that North Korean children are supposed to attend.
2-1 Assistance targeted at the most vulnerable in the province of North Hamgyong
North Hamgyong is one of the country's most populous provinces with 2.2 million inhabitants. It is situated in the north of the country, bordering Russia and China. The geographical situation of this mountain zone is unfavourable for agriculture as only 6% of the land is arable (against a national average of 18%). It is known that the agricultural production of this region cannot cover the local nutritional requirements on its own.
When they arrived in the province of North Hamgyong the humanitarian volunteers of Action against Hunger gave the following description:
"A region dull and economically stagnant. Chongjin, the capital of the region, is a large industrial town that has gone adrift. All the factories, or nearly all of them, are closed; only a few cars run." The collection and transport of wood seem to be one of the main occupations all through winter. A lot of people, including children, walk along the roads carrying large bundles of sticks. Wood is the only means of heating. The Koreans are thus razing their forests to the ground."
In 1999/2000 the province of North Hamgyong is faced with a food deficit of 238.000 tons. The agricultural production of the province only gives a food allowance of 170 grams per person per day.
In this province a majority of the population lives in the towns and 78% of the population depend on the Public Distribution System (which is supposed to distribute basic foodstuffs to the population). In 1999 however this system distributed nothing. Indeed, because of transport difficulties, the country's southern provinces that were traditionally the country's bred basket no longer supply any of the northern provinces. The province is therefore completely dependent on external assistance to meet the nutritional needs of the population.
North Hamgyong's population fights hard to survive. Every plot of land is used, even the top of the hills. The inhabitants of towns raise chickens and rabbits on their balconies. Local markets have started up that are apparently the only source of fresh supplies for many people living in the towns. These are so packed with people that they are very visible to Action against Hunger's humanitarian volunteers but they can never obtain permission to even visit them: the authorities absolutely refuse to acknowledge the existence of these markets since they are hardly tolerated in the socialist economy.
In this context of food shortage, and concerned with the problem of bringing assistance to the most vulnerable populations, Action against Hunger has orientated it's interventions towards nutritional assistance to children.
2-2 The deadlock, with the programmes limited to structures supervised by the state
As well as supplying the food products that the North Korean authorities received eagerly, the humanitarian volunteers of Action against Hunger were also able to start programmes more oriented towards a qualitative approach such as water quality control testing and training programmes.
A nutritional support programme for day nurseries and kindergartens
In 1998 and 99, Action against Hunger carried out a nutritional support programme. The aims of the humanitarian workers were to improve the health and the nutritional condition of the "official" 108.023 children under five attending 1.442 nurseries and of 61.741 children of 5 and 6 years old in the 1.098 kindergartens. This programme was carried out in the 12 districts of North Hamgyong province where access was allowed to humanitarian organisations.
Two nutritionists from Action against Hunger trained nurses and doctors from the nurseries, doctors from the paediatric hospitals and representatives of the Ministry of Health in the basic detection methods and the treatment of malnutrition. Today all the nurseries of the region are able to follow the growth of children with locally adapted instruments - height gauges, scales - supplied by Action against Hunger, and to treat them effectively by using specific foods such as cereal milk, oil, sugar. These are also supplied by the Action against Hunger.
Distribution of hygiene products - soap, shampoo, washing powder, antiseptic lotions - has also been organised in both the nurseries and the kindergartens to improve the hygiene in these much frequented places.
A water evaluation programme
Because the humanitarian volunteers of Action against Hunger had identified many cases of diarrhoea amongst children in the nurseries and the kindergartens, they also set in place a programme to monitor water quality. This surveillance, carried out on 14 water networks in the main urban areas of the province, has revealed that the water being distributed was polluted. Although the authorities advise everyone to boil their water the lack of availability of energy sources is one of the major problems confronting people and it is very doubtful that this recommendation is ever followed.
However, these programmes, even if they have allowed a little better understanding of the humanitarian context in North Korea, have never gained Action against Hunger's humanitarian volunteers access to the most deprived people they have seen on many occasions:
Gleaning a few rice grains
"We have seen old people in the fields where the rice had been gathered, picking up grain by grain the rice which had fallen from the ears"
or a little powdered milk
"At the station, when the milk powder was unloaded, street children used to poke pieces of wood through the slits of the wagons' air vents. A small piece of plastic placed below the wagons allowed them to gather a little of the milk powder coming from the bags they had pierced. Other children gathered up milk that had fallen on the rails. We have seen them do the same thing to trucks transporting chemical fertilisers, which they presumably had imagined to be food."
It is evident to Action against Hunger that hundreds of thousands of North Koreans have never had access to international aid, including the assistance which Action against Hunger itself has tried to provide through its programmes.
II. The impossibility of humanitarian action
After two years in North Korea and many repeated attempts, Action against Hunger is obliged to admit that it has been unable to obtain even minimal access to the most needy of the population
1- Access denied access to the most vulnerable populations
The development and implementation of humanitarian assistance programmes in North Korea are totally controlled by the authorities. All humanitarian programmes must be implemented through the administrative structures of the Korean regime. Given this, the main question is : which sectors of the Korean population really have access to the structures opened with the aid of humanitarian assistance?
According to the observations of the Action against Hunger teams, all these structures, from the System of Public Distribution, the farms, the hospitals to even the nurseries and kindergartens (in which Action against Hunger has worked), are there simply to function as an opaque screen between the humanitarian organisations and the most deprived populations. One of the main criteria of vulnerability, in North Korea, is precisely the exclusion of a large part of the population from these official structures.
By confining humanitarian organisations to the support of these state structures that we know are not representative of the real situation of malnutrition in the country the authorities are deliberately depriving hundreds of thousands of truly needy Koreans of assistance. As a consequence any humanitarian assistance provided is only helping the populations which the regime has chosen to favour and support, and which are certainly not the most deprived.
1-1 Assistance channelled via structures which do not provide for the deprived
Through its programme of support to day nurseries and kindergartens in the North Hamgyong province, Action against Hunger has tested all the limits of action via these structures. It has proved impossible to reach children suffering from malnutrition since they do not attend these structures. Yet the whole logic of the intervention was to find a means of bringing them assistance and to work closely with them. This was despite a strong presence in the field: Action against Hunger had five expatriates based in Chongjin, the capital of the province, and has been the only organisation that has been able to maintain such a presence continuously.
Nutritionists from Action against Hunger have only exceptionally seen cases of malnutrition in the day nurseries (which take children under five). Growth monitoring put into place by Action against Hunger in 1998 and 1999 in sentry day nurseries of the North Hamgyong province has revealed that less than 1% of children attending these institutions were undernourished. Yet the nutrition survey conducted in October 1998 by WFP, UNICEF and the European Union had shown that nearly 16% of North Korean children were suffering from malnutrition.
How can such a difference be explained?
Action against Hunger teams have rapidly had to face the facts: children attending these structures were for the most part healthy children. There was no trace of the emaciated, starving children, whom the humanitarian volunteers often glimpsed when they went to towns and villages.
This has been implicitly confirmed by the directors of several of the day nurseries, who have explained that undernourished children belonged to their day nurseries but did not attend them because they were too ill or too weak. Action against Hunger strongly doubt that any of the intended assistance reaches such children, unfortunately.
The most vulnerable populations are not accessible through the state structures that the Korean authorities intend to utilise to control the humanitarian assistance.
The existence of malnutrition however cannot be denied
The evidence is the street children, in rags and with sallow complexions, abandoned, who are seen everyday by the humanitarian workers of Action against Hunger. The existence of these children is denied, erased by the authorities. These are children to whom access is barred since the provision of all assistance has to be officially approved, and none is permitted outside the government structures.
Malnutrition, in its most severe forms, has also been seen by the humanitarian volunteers of Action against Hunger, within the 'orphanages' of Chongjin.
1-2 Assistance that does not reach children suffering from hunger: the case of the "orphanages"
The Action against Hunger humanitarian workers were able to visit two institutions presented as the official orphanages of the North Hamgyong capital visit, on three occasions, between 1998 and 1999. During a visit in July 1999, of a total of 380 children (in two centres, one receiving children from the age of 0 to 4, the other children 5 and 6 years old) the proportion of undernourished children reached over 20%, the majority presenting symptoms of extremely serious malnutrition. The humanitarian volunteers saw children who were shocked and huddled together with vacant stares and suffering from marasmus. Malnutrition, absent in the nurseries and kindergartens, was certainly evident there.
The most severe cases were the children aged under one. The majority of these urgently needed to be fed by a nasal-gastric catheters and be re-hydrated or they would die within days. All the children were neglected, wrapped in filthy cloths and suffering from skin infections like pyodermatitis and scabies.
Why were these children not treated? Who were they?
The explanations of the North Korean staff about the origin of these children were, to say the least, confused. Children said to be orphans (parents who had died), children from single-parent families, from "families in difficulty", children whose parents "do not play their role correctly", undernourished children who will "quit the structure once they are cured" and then 'return to their families'.
In fact these "orphanages" do not only take in orphans. Their resemblance is more to social institutions where unwanted children are simply hidden away from society and largely deprived of resources. In fact these children are barely taken care of, if at all, and these institutions are at the present time essentially places to die, according to the observations of the humanitarian volunteers. No treatment at all is given for malnutrition, and the undernourished children are certainly not even referred to the hospital system according to the Korean staff themselves. Indeed an Action against Hunger team who were able to visit a paediatric hospital in Chongjin did not see any undernourished children there, and nor did the hospital have available any specific re-nutrition products which are the mainstay of treating malnutrition.
Once these serious shortcomings were realised Action against Hunger proposed establishing a therapeutic re-nutrition unit in the Chongjin orphanage, to implement treatment of malnutrition. The Korean authorities refused to accept this offer of assistance in October 1999 without any real explanation. According to the North Korean authorities, undernourished children were "taken care of by the provincial authorities" and "the province will improve the children's condition by their own means, without the help of outside assistance". The Korean authority's refusal is criminal as Action against Hunger could have saved the lives of these children if they had been able to treat them.
Action against Hunger's humanitarian volunteers also strongly suspect that in some families severely undernourished children are just kept inside and without assistance condemned to slow death. They have never been able to obtain permission to visit such households, in spite of multiple requests.
1-3 The failure of a final attempt to gain access to the most vulnerable
Having observed that the most vulnerable populations do not have access to the state structures that channel assistance, Action against Hunger proposed setting up a system for direct distribution of hot meals via canteens in the streets of Chongjin.
The Korean authorities refused to accept the way Action against Hunger proposed to implement this project, particularly the basic monitoring system Action against Hunger insisted would be necessary to ensure the programme really did benefit the intended groups of the deprived.
2- Opacity that does not allow us to evaluate the results of our intervention
Despite Action against Hunger having worked for two years in North Hamgyong, it has proved impossible for us to ever survey the rates of children's malnutrition in the area. Action against Hunger volunteers are only allowed to visit what North Korea's government wants them to see.
Action against Hunger's volunteers have ended up with a complete absence of the objective data which would allow them to assess the state of the populace and target their activities. The only data accessible is that provided by the North Korean state, and that cannot be checked and is known to have variable quality . For example, the list of the people included in Action against Hunger's nutrition programme in North Hamgyong province had been changed and the numbers revised downward between 1998 and 1999 without any explanation. In 1998 the list submitted by North Korea's authorities stated that 205 000 children were attending nurseries and kindergartens. In 1999 this figure had been lowered to 157 000 for the same number of districts so within one year there was a difference of nearly 48 000 children. It seems likely that the number beneficiaries number listed in 1998 was a gross overestimate. Does that imply Action against Hunger made distributions for 50 000 people who did not exist? Where, or who, did this assistance go to?
In many cases data are unquestionably false.
During over 230 visits in North Hamgyong nurseries carried out in 1998 & 1999 Action against Hunger's nutritionists were able to make comparisons between the number of children actually present in these institutions and the number of children declared or reported by the authorities. The quantities of food assistance distributed by our association was based on these latter numbers. It was clear that the nursery directors significantly overestimated the numbers of children actually present in these institutions as only about half of those claimed were ever actually observed attending. No clear explanation was ever given for the discrepancies. Some of the "reasons" offered included "ill children", "as today is holiday children are with their parents", and "there is a turnover of children in nurseries according to parents' work" (when almost all the factories in the province were idle).
Sometimes more worrying explanations were given a nursery directors including "children are severely malnourished and they are thus too weak to come to the nursery".
The number of the nurseries in the districts is also likely to have been hugely overestimated. Action against Hunger has never been given a list of the names of the nurseries and kindergartens it supports. Nutritionists who had requested they be allowed to visit 4 nurseries a day were only authorised to visit 3 for the whole of 1999. North Korean officials were unable to show them a single nursery they had not already visited during the previous year. Our presumption from this is that our nutritionists must have visited most of the nurseries in the province, (or at least all the ones which "could" be shown). The number of institutions they visited was just over 200 ; the official figure of the nurseries in the province exceeds 1000.
Such a discrepancy raises questions about the final destination of the aid intended for the remainder of the 1000 'nurseries'. There is little doubt the assistance was largely diverted and that a large number of institutions claimed to be being supplied simply do not exist. This opacity of the system, maintained by the authorities, is for them the guarantee they have keep all the advantage. The authorities are constantly trying to reduce the possibility of anyone else finding out what the humanitarian situation really is, in the same way they try to prevent anyone else finding out just how some of the state controlled bodies work
3. Humanitarian actors under control
Relief organisations' volunteers may not travel alone outside the capital city Pyongyang. They are always accompanied by a translator the government puts at their disposal, which makes it impossible to have any direct and free exchange with the North Korean population.
Every volunteer's travel must be planned beforehand. Expatriates are expected to submit a detailed itinerary of the Action against Hunger's assisted institutions they wish to visit a week in advance. This obviously makes it possible for the authorities to "prepare" for the visits. Although stocks of foodstuffs were duly available when our volunteers visited nurseries and kindergartens, the kitchens sometimes seemed to have never been used. A few establishment directors answered the questions asked by Action against Hunger's nutritionists by reading notes worked out beforehand. They spoke in a very controlled manner and sometimes their replies seemed to being "corrected" by the translator.
All plans must be submitted for approval and requests for access to new establishments by Action against Hunger's volunteers. This always led to dispute with officials who always tried as hard as possible to reduce their travels or stop them. Surprise visits to institutions have never been possib