North Korean Economy Watch

UPDATE 32 (2012-1-27): According to an article in the New York Times, inter-Korean trade and aid declined in 2011:

On Friday, the South’s Unification Ministry said that South Korean aid to the North fell to 19.6 billion won, or $17.5 million, last year [2011], down more than 51 percent from a year earlier [2010].

Inter-Korean trade fell by more than 10 percent [from 2010 to 2011] to about $1.5 million in 2011, the ministry said.

UPDATE 31 (2011-12-10): According to the Korea Times, the potential food aid is not being auctioned off.  It is being sent to South America. According to the article:

Seoul will send baby food originally offered as aid to North Korea to El Salvador following Pyongyang’s refusal to accept delivery, to help the South American country deal with damaging floods, officials said Friday.

The delivery consists of 190,000 packs of baby food that were part of a $4.4 million flood aid package to the North, which the Stalinist regime rejected two months ago amid high tension.

It was slated to depart from the port city of Busan via cargo ship for El Salvador, which has appealed for help to deal with floods that displaced tens of thousands earlier this year.

Seoul offered the aid, which also included biscuits and instant noodles, to help the North deal with torrential summer rains. But Pyongyang demanded cement and equipment instead and eventually shunned the offer altogether.

The rerouting of the items underscores lingering tension despite efforts to warm ties and eventually resume regional dialogue on dismantling the North’s nuclear program. Regional players want the situation on the peninsula to improve before the talks begin.

Pyongyang’s silence over the aid put a damper on the early signs of improvement. President Lee Myung-bak has been exercising a softer line since September, when he tapped close aide Yu Woo-ik as unification minister, including expanding humanitarian activities and cultural exchanges.

But the North, apparently seeking rice and other forms of massive aid, has recently slammed the flexible policy as political pandering to the South Korean public, which is gearing up for elections next year.

Such remarks come even as the unification ministry continues to approve northbound aid, including $5.65 million worth for infants, children and pregnant women through the United Nations Children’s Fund (UNICEF). Consultations are ongoing over how to provide more of the baby food. Seoul has also attempted to auction some of it off through a government website.

The North Korean regime is thought to be doing all it can to secure food and other handouts ahead of next April, when it will celebrate the 100th anniversary of the birth of its founder Kim Il-sung. Watchers say that the North is liable to alternate pressure and peace offensives to secure as much aid as it can through inter-Korean and multilateral channels.

UPDATE 30 (2011-12-6): According to the Korean Herald the first auction of potential food aid (See Update 27 below) did not go so well, so Seoul is trying again:

South Korea plans a second attempt to auction off baby food originally intended for North Korean children, officials said Tuesday.

The move comes after nobody bid for 540,000 packs of baby food on Onbid, an auction Web site run by the state-run Korea Asset Management Corp.

South Korea plans to issue a second public notice and adjust the prices, said an official handling the issue at the Unification Ministry. He did not elaborate on further details.

The baby food is part of 5 billion won ($4.4 million) worth of emergency relief aid South Korea had planned to ship to North Korean flood victims earlier this year.

South Korea dropped that plan in October after differences between the two Koreas on the items to be sent. South Korea had insisted it would deliver baby food, biscuits and instant noodles to the North, instead of the cement and equipment its communist neighbor had requested.

Separately, South Korea has been in talks with local private relief agencies over how to donate another 290,000 packs of baby food to other countries, according to another ministry official.

She declined to give further details, saying consultations are taking place.

UPDATE 29 (2011-12-5): The South Koreans will donate US$5.65 million to the DPRK via UNICEF.  Accoring to Yonhap:

South Korea said Monday it will donate US$5.65 million (about 6.5 billion won) for humanitarian projects in North Korea through the U.N. body responsible for the rights of children.

The donation to the United Nations Children’s Fund, or UNICEF, will benefit about 1.46 million infants, children and pregnant women in North Korea, according to the Unification Ministry, which is in charge of relations with the North.

Seoul’s contribution will be used to provide vaccines and other medical supplies as well as to treat malnourished children next year, said the ministry.

There have been concerns that a third of all North Korean children under five are chronically malnourished and that many more children are at risk of slipping into acute stages of malnutrition unless targeted assistance is sustained.

“The decision is in line with the government’s basic stance of maintaining its pure humanitarian aid projects for vulnerable people regardless of political situation,” Unification Ministry spokesman Choi Boh-seon told reporters.

South Korea has been seeking flexibility in its policies toward the North to try to improve their strained relations over the North’s two deadly attacks on the South last year.

…

South Korea donated $20 million for humanitarian projects in North Korea through the UNICEF between 1996 and 2009.

Last month, the South also resumed some $6.94 million worth of medical aid to the impoverished communist country through the World Health Organization.

..

Separately, South Korea also decided to give 2.7 billion won ($2.3 million) to a foundation to help build emergency medical facilities in an industrial complex in the North Korean border city of Kaesong.

More than 47,000 North Koreans work at about 120 South Korean firms operating in the industrial zone to produce clothes, utensils, watches and other goods. The project serves as a key legitimate cash cow for the impoverished communist country.

UPDATE 28 (2011-12-1): Distribution of private aid monitored in N.Korea. According to the Hankyoreh:

“North Koreans know that the wheat flour aid they received came from South Korea.”

These were the words of Cho Joong-hoon, director of the Unification Ministry’s humanitarian assistance division, during a meeting with reporters Wednesday at the Central Governmental Complex in Seoul upon his return from a recent visit to North Korea to monitor the distribution of aid.

“The name of the South Korean private aid group, the manufacturing company, the date, and the address were all printed on the packages of flour,” Cho said.

Arriving in North Korea on Sunday with Kim Min-ha, co-chairman of the private group Ambassadors for Peace, and three others, Cho visited three sites to observe the distribution of the 300 tons of flour provided in aid. The site were the Namchol Kindergarten, February 16 Refinery Kindergarten, and Tongmun Nursery in Chongju, North Pyongan.

It was the first visit to any part of North Korea besides Kaseong and Mt. Kumkang by a government official in the one year since the Yeonpyeong Island artillery attack on Nov. 23, 2010.

Cho said that the distribution, storage, preparation, and supply of the flour were monitored and that everything was confirmed to be proceeding as planned.

On the situation on the ground, Cho said, “Judging simply from the nursery and two kindergartens, the children’s nutritional condition does not appear to be good.” Cho noted that no heating was being supplied to the facilities despite the cold weather.

Cho said that while North Korean authorities did not official request food aid, a request was made under unofficial circumstances.

Cho also noted that construction efforts were under way on a highway connecting Pyongyang with Sinuiju.

“It is not very far from Pyongyang to Chongju, but I think the trip took about four hours because of the detour around the highway construction,” he said.

Analysts said this appears to be linked to hurried infrastructure building efforts, including highway servicing and construction, amid recent moves by North Korea to rebuild its economy through a stronger economic partnership with China.

UPDATE  27 (2011-11-29): Seoul auctions off “unwanted” DPRK food assistance. According ot the Korea Times:

South Korea has taken steps to auction off some baby food originally intended for North Korean children, an official said Tuesday.

The move comes nearly two months after South Korea dropped a plan to send 5 billion won ($4.3 million) worth of aid to North Korean flood victims, citing no response from the North as the reason for the change of plan.

South Korea had insisted it would deliver baby food, biscuits and instant noodles to the North instead of cement and equipment requested by the North.

South Korea’s Red Cross, which handles relief aid to the North, gave public notice of a bid for 540,000 packs of baby food on Onbid, an auction website run by the state-run Korea Asset Management Corp.

Separately, South Korea has been in talks with local private relief agencies over how to donate the other 290,000 packs of baby food to foreign countries.

Unification Minister Yu Woo-ik has ruled out rice aid to the communist country unless Pyongyang admits to last year’s deadly provocations.

South Korea suspended unconditional aid in 2008 and imposed sanctions on the North last year in retaliation for the sinking of a South Korean warship that was blamed on the North.

The North has denied involvement in the sinking that killed 46 sailors. It also shelled a South Korean border island in November 2010, killing four South Koreans.

Still, South Korea has selectively allowed religious and private aid groups to deliver humanitarian and medical assistance to North Korea.

Also on Tuesday, a Unification Ministry official and four civilians were to return home after a rare trip to the North aimed at ensuring that South Korea’s recent private aid had reached its intended beneficiaries.

UPDATE 26 (2011-11-25): According to Yonhap, ROK officials are traveling to the DPRK to monitor food aid:

A South Korean official and four civilians left for North Korea on Friday on a rare mission to ensure that recent aid from Seoul had reached its intended beneficiaries, an official said.

The trip comes a day after North Korea threatened to turn South Korea’s presidential office into “a sea of fire” in anger over Seoul’s massive military maneuvers near the tense sea border.

…

The Unification Ministry official and four civilians were to arrive in the North’s capital later Friday via Beijing, according to the Unification Ministry, which handles inter-Korean affairs.

It is first time that North Korea has allowed a South Korean official to travel to the isolated country to monitor aid since a conservative government took power in Seoul in 2008.

They are scheduled to visit a day care center and two other child care facilities in the northwestern city of Jongju to monitor how 300 tons of flour were distributed to children and other recipients, according to a civic group.

Ambassadors for Peace Association, a civic group that is partly funded by the Unification Group, donated the flour to Jongju, the birthplace of Unification Church founder Moon Sun-myung.

The civic group said the monitors also plan to discuss details on another 300 tons of flour aid before returning home Tuesday. Some members of the civic group are associated with the controversial Unification Church.

Read previous posts on the ROK’s aid to the DPRK in 2011 below:

(more…)

According to Yonhap:

Multidrug-resistant tuberculosis has emerged as a major public health problem for North Korea, a private foundation said Thursday, calling for public donation to help combat the highly contagious disease.

Stephen W. Linton, chairman of the Eugene Bell Foundation, said his foundation currently treats some 600 multidrug-resistant patients in six medical centers in the North, but hundreds of people are still on the waiting list.

You can read more about the Eugene Bell Foundation’s work in the DPRK here.

Previous posts on the Eugene Bell Foundation here. Their web page is here.

Read the Yonhap story here:
Multidrug-resistant tuberculosis poses public health risk in N. Korea
Yonhap
2011/10/27

1. “Relying on One’s Strength: The Growth of the Private Agriculture in Borderland Areas of North Korea”
Andrei Lankov，Seok Hyang Kim ，Inok Kwa
PDF of the article here 

The two decades which followed the collapse of the communist bloc were a period of dramatic social and economic transformation in North Korea. The 1990-2010 period was a time when market economy re-emerged in North Korea where once could be seen as the most perfect example of the Stalinist economic model. The present article deals with one of the major areas of socioeconomic change which, so far, has not been the focus of previous studies. The topic is about the growth of private agricultural activities in North Korea after 1990. This growth constitutes a significant phenomenon which has important social consequences and also is important from a purely economic point of view: it seems that the spontaneous growth of private plots played a major role in the recent improvement of the food situation inside North Korea.

______________________

3. Korea Sharing Movement anti-malarial program (Via Cancor)
Read a PDF of on the project here

______________________

4. What is it like to teach at the Pyongyang University of Science and Technology (PUST)?
Find out from one instructor here. More on PUST here.

According to Yonhap:

Seok, 46, who defected to the South in 1998, is known for practicing North Korea’s “royal court medicine” that he learned while working at Pyongyang’s top medical research center devoted solely to caring for the health of leader Kim Jong-il.

The research institute is known in South Korea as the Kim Il-sung Longevity Research Institute after the name of the North’s late national founder and father of the current leader. Among North Koreans, it is simply called the “long life research institute,” Seok said, dressed in a white lab coat during a recent interview at his two-story clinic.

“Simply put, the long life research institute is to look after the general,” Seok said, referring to the North’s leader. “I was with the cardiovascular and anti-aging team at the institute.”

Details about the secrecy-shrouded Basic Medicine Research Center in Pyongyang are scarce, but the institute was believed to have hundreds of herbal doctors, physicians, biologists and other scientists working to make sure that the North Korean leader lives for a long time and in good health, Seok said.

Newly developed treatment methods, Seok said, were first tested on people similar to the leader in age and body type and with heart disease, an illness that killed late leader Kim Il-sung in 1994 and the current leader Kim Jong-il, now 68, is believed to be suffering from.

“These people were considered lucky because they were treated with good medicine,” Seok recalled.

Besides medical research, the longevity institute was also charged with growing high-quality organic rice, fruits and other agricultural products for the leader, even burying dogs in the farm fields as fertilizer, he said.

A top graduate from the North’s prestigious Pyongyang Medical College, Seok said he was plucked by authorities and assigned the research center regardless of his desires. Most graduates wanted to work at general hospitals where they could make more money.

“It’s not a place you can apply to work at. It’s a place you are dragged into,” Seok said with a chuckle that appears to imply a sense of relief that he is no longer in the totalitarian nation and lives a happy life in South Korea.

Read the full story here:
Oriental medicine doctor gives S. Koreans tastes of N. Korea’s ‘royal court medicine’
Yonhap
2011-8-22

From a recent Newsweek article about meth use in the DPRK:

First synthesized in 1893, meth is now one of the world’s most widely abused drugs, imbuing the user with intense feelings of euphoria, concentration, and grandiosity. Smoked, injected or snorted, the drug also suppresses the need for food and sleep for an extended period of time; coming down can bring fatigue, anxiety, and occasionally suicidal ideation.

Inside North Korea, observers say, many use meth in place of expensive and hard-to-obtain medicine. “People with chronic disease take it until they’re addicted,” says one worker for a South Korea-based NGO, who requested anonymity in order to avoid jeopardizing his work with defectors. “They take it for things like cancer. This drug is their sole form of medication,” says the NGO worker, who has interviewed hundreds of defectors in the past three years. A former bicycle smuggler who defected in 2009 told NEWSWEEK of seeing a doctor administering meth to a friend’s sick father. “He took it and could speak well and move his hand again five minutes later. Because of this kind of effect, elderly people really took to this medicine.”

Jiro Ishimaru, founder and editor of Rimjin-gang, a magazine about North Korea and reported by people inside the country but published in Japan, says he has seen several North Koreans take meth to relieve stress and fatigue, including his former North Korean business partner. “He didn’t start taking it as a drug but as a medicine,” Ishimaru says.

The drug also offers an escape that might not otherwise be possible. As Shin puts it: “There’s so little hope in North Korea—that’s why ice is becoming popular. People have given up.”

Read the full story here:
North Korea’s Meth Export
Newsweek
Isaac Stone Fish
2011-6-19

UPDATE 6 (2011-4-20): The DPRK is experiencing a new wave of foot and mouth outbreaks.  According to Yonhap:

A new outbreak of foot-and-mouth disease (FMD) occurred in four counties in North Korea last month and infected nearly 300 pigs and cows, a news report said Wednesday.

A total of 141 out of 298 animals died after being infected with the disease, the Voice of America said, citing a North Korean report submitted to the World Organization for Animal Health (OIE) on Monday. The news report said Pyongyang quarantined the infected areas in an apparent attempt to stem the spread of the disease.

The North confirmed its first case of the disease in December, and the virus has since spread to six other cities and provinces, Seoul’s Agriculture Minister Yoo Jeong-bok said in February.

Last month, the World Organization for Animal Health said North Korea urgently needed around US$1 million worth of equipment and vaccines to help stem outbreaks of the deadly disease.

The disease does not pose a direct health threat to humans, but affects cows, sheep, goats and other cloven-hoofed animals, causing blisters on the nose, mouth, hooves and teats.

North Korea has 577,000 heads of cattle, 2.2 million pigs and 3.5 million goats, according to the OIE.

The OIE data mentioned in the above Yonhap story can be found here.

The OIE provides the map below as well as details about the outbreaks:

Three of the four cases take place in North Hwanghae:

Sinphyong county, Myongri district (2011-3-21)

Sangwon county, Rodong-ri (2011-3-16)

Hwangju county, Ryongchon-ri (2011-4-4)

The final case is in Singyo-ri, Kumgang County, Kangwon Province. It reportedly took place on 2011-4-6.

The data is also available here.

UPDATE 5 (2011-3-24): UN FAO Press Release:

North Korea: FAO says urgent vaccine and equipment needed to contain Foot-and-Mouth Disease

Capacity of national veterinary services to manage animal disease must also be strengthened

24 March 2010, Rome/Paris – Around a million dollars of equipment and vaccines are urgently required to help stem outbreaks of deadly Foot-and-Mouth disease (FMD) in North Korea, followed by a more prolonged and concerted effort to modernize veterinary services in the country.

A joint FAO and World Organization for Animal Health (OIE) mission travelled to North Korea at the government’s request between 27 February and 8 March. The mission found that the country’s capacity and that of veterinary services to detect and contain FMD outbreaks need significant strengthening — in particular as regards implementing best-practices in biosecurity measures and improving laboratory infrastructure and capacity.

Outbreaks of Type-O FMD have been reported in diverse locations in eight of North Korea’s 13 provinces. To bring the situation under control, the team recommended the following steps:

• Thorough surveillance to locate and map disease clusters
• Protecting unaffected farms through movement controls and biosecurity measures
• Adequate sampling in order to correctly identify the virus strain or strains involved
• Improving biosecurity measures to prevent further spread of the disease
• The strategic use of the appropriate vaccines to contain and isolate disease clusters

FAO estimates around $1 million is required immediately for training, supplies and infrastructure, vaccine acquisition and the setting up of monitoring, reporting and response systems.

The FAO-OIE mission visited several collective farms as well as the national veterinary laboratory and various animal health field stations.

Virus identification

FAO and OIE provided guidance to North Korean veterinary authorities on taking and handling of FMD samples — new samples will be collected by North Korea and sent to an international reference laboratory for testing.

Only by accurately typing the virus or viruses involved in the outbreaks will it be possible to identify the most effective vaccine to use against it.

Food security bulwark

FMD does not pose a direct health threat to humans, but affected animals become too weak to be used to plough the soil or reap harvests, suffer significant weight loss, and produce less milk. Many animals are dying from the disease.

Farm animals are crucial to food security in North Korea. Cows and oxen are primarily used for dairy production and are a key source of draft power in agricultural production. Goats and pigs, also susceptible to FMD, are important source of dairy products and meat.

Current North Korea’s livestock population consists of 577,000 head of cattle, 2.2 million pigs and 3.5 million goats.

FMD affects cattle, buffaloes, sheep, goats, swine and other cloven-hoofed animals. It is highly contagious and spreads through mucus, saliva or body fluids that can contaminate materials such as clothing, crates, truck beds, and hay and be transmitted to other animals.

UPDATE 4 (2011-3-22): Pork prices rising with FMD meat on sale.  According to the Daily NK:

With North Korea seemingly unable to bring an outbreak of foot-and-mouth disease centered on the Pyongyang region under control, inside sources have revealed that the price of good pork in the markets is skyrocketing as a result of diminishing supplies, while infected meat is being sold on the quiet for lower prices.

Speaking with The Daily NK on the 22nd, a source from North Pyongan Province explained, “Pork is right now selling for 6,000 won per kilo in the market. The price, which was 2,600 won in the market last December, is climbing all the time, and now is at the point where the average person has no chance of being able to buy it.”

According to sources, the situation is similar in Nampo, where pork was selling for 3,500 won in December, but had reached 6,500 won by February. In Sariwon in North Hwanghae Province, the price had hit 5,000 won by the end of February.

The news of an emerging foot-and-mouth disease problem in North Korea first emerged through sources earlier this year, but the authorities only confirmed it officially and reported control measures via Chosun Central News Agency on February 10th.

According to an official report submitted by the North Korean authorities to the World Organization for Animal Health (OIE) at around the same time, the outbreak had by then spread to 48 places across much of south and central North Korea, with 15 of those places falling within the Pyongyang administrative region.

The report outlined how North Korea first attempted to combat the outbreak with an indigenously produced vaccine, but this was of limited use. It also noted that official North Korean policy is to bury those animals that die from the disease and quarantine those that are infected.

However, inside sources say that in reality people are digging up buried animals in order to sell the meat in the market at a lower price.

The North Pyongan Province source explained, “Meat infected with foot-and-mouth disease is being sold in the market tacitly; the price of it is somewhat lower. The work of burying pigs with foot-and-mouth disease is being done, he said, but it is said that animals continue to be dug up and are sometimes being sold in the market.”

The source gave the example of a pig farm in Pyongsung, where 6 people dug up previously buried pigs last December to sell in Pyongsung Market. They were selling the meat for 2,000 won/kg, he said, but were caught by the authorities.

The source also revealed that on December 30th, 2010, 500 pigs were buried near Pyongyang, but two days later had disappeared, while in Sinuiju it is said that “If it is buried in the daytime, people say that by that very evening it will appear in the market.”

Of course, the fact is that the North Korean authorities are unable to put in place an efficacious policy to combat the outbreak of foot-and-mouth disease or the selling on of infected meat, not least because persons caught for selling infected meat can simply navigate their way out of trouble and go back to their activities.

UPDATE 3 (2011-3-2): A UN FAO team is in the DPRK to inspect the foot-and-mouth outbreak.  According to the Joongang Ilbo:

An official at the FAO was quoted by RFA as saying that the scale and variety of the aid would be determined after discussions with North Korean government officials. The exact itinerary of the group was not released.

The UN food agency also said that along with the team that arrived in North Korea last month, additional officials, including an expert on contagious diseases, would be sent to the area.

The South Korean government has said that it has been monitoring the development of the outbreak. However, the South Korean Ministry of Unification said after North Korea’s official report on the disease that Pyongyang has not made any requests for aid nor did Seoul have plans to offer any assistance.

North Korea announced on Feb. 10 that over 10,000 pigs and cattle had been infected with FMD, prompting North Korean officials to alert the UN of the outbreak.

The North struggled with FMD cases in 2007 and 2008, which led to the culling of thousands of pigs and cattle. During those episodes, the FAO and the South Korean government provided aid.

UPDATE 2 (2011-2-27): The Daily NK reports that the OIE report shows animals are not being culled:

Unlike in 2007, when North Korea reacted swiftly to an outbreak of the disease by culling animals, this time the authorities appear to have reacted poorly despite the fact that the disease has now been found at more than 48 locations in Pyongyang City and Pyongan, Hwanghae and Kangwon Provinces.

According to an OiE report derived from the letter, in which the North finally confirmed the rumored outbreak after a month of silence, Pyongyang has apparently tried to address the situation using a combination of disinfection measures and a domestically produced vaccine, but this has met with little success.

“Given the number of livestock which have died of foot-and-mouth disease, it is uncertain just how far the infection has spread,” Korea Rural Economic Institute Vice-President Kwon Tae Jin explained to The Daily NK. “The small number of infected heads of cattle reported by North Korea is also difficult to accept at face value.”

“If the North Korean authorities have not destroyed the infected cows and pigs in the hope that they will recover, then it is a serious problem. It means we have no idea how far the disease has spread,” Kwon added.

15 of the existing locations in which the disease has so far been detected are in Pyongyang and surrounding areas. In order to combat the spread of the disease to other regions, the authorities are said to have implemented across-the-board restrictions on movement into and out of the city.

However, news of the disease has still not been reported officially, and domestic sources have told The Daily NK that they have not heard anything about it to date.

UPDATE 1 (2011-2-18): DPRK report (below) shows extensive damage from foot-and-mouth disease.  According to Yonhap:

North Korea has reported to a global animal health agency that it had suffered a total of 48 outbreaks of foot-and-mouth disease (FMD) since Christmas last year.

The impoverished communist state made the report to the Paris-based World Organization for Animal Health (OIE) on Feb. 8, saying about half of 17,522 “susceptible” pigs had died from the disease.

Only 3 percent of 1,403 cows suspected of being infected had died from the disease, according to the report posted on the OIE Web site, while none of the 165 susceptible goats had died.

At the time the report was filed, no livestock were yet culled as a preventive measure, according to the report created by Ri Kyong-gun, a quarantine director for the Ministry of Agriculture. A map of outbreaks showed the disease had spread out over almost half of North Korea.

“Vaccination has been applied with a locally developed vaccine but was not effective to control the disease,” the report said, adding that the origin of the outbreak remains “unknown or inconclusive.”

North Korea has banned the inflow of pork and beef from South Korea since late last year for fear that the disease — rampant south of the heavily armed border — may spread there.

Despite the measure, the North, which suffers serious food shortages, reported the outbreak to the United Nation’s Food and Agriculture Organization earlier this year.

The country said in the OIE report that it has restricted movement and conducted “disinfection of infected premises and establishments” to fight the spread of the animal disease.

In 2007, North Korea suffered similar outbreaks, prompting South Korea to dispatch a team of animal health experts amid a mood of reconciliation.

FMD is highly contagious and affects cloven-hoofed animals like cattle, pigs, deer, goats and sheep. The disease causes blisters on the mouth and feet of livestock and leads to death. It is rarely transmitted to humans.

ORIGINAL POST (2011-2-18): Below is a map and list of reported foot and mouth disease outbreaks in the DPRK:

The World Organisation for Animal Health (OIE) has reported 48 outbreaks of foot and mouth disease (FMD) in Democratic People’s Republic of Korea.

The outbreaks are located in:

–Kangwon (Anbyon, Kimhwa, Phangyo, Phyonggang)
–Kumgang
–Pyongyang (Sadong, Ryokpo, Rakrang, Kangdong, Mangyongdae)
–Nampho (Nampho and Kangso)
–North Hwanghae (Kangnam, Sangwon, Hwangju, Yonsan, Sinphyong, Suan, Songrim)
–North Pyongan (Thaechon, Pakchon)
–South Hwanghae (Chongdan)
–South Pyongan (Anju, Phyongwon)

The OIE posted a report developed from an official letter sent by the DPRK dated 7 February 2011 and received on 8 February 2011.  You can see the OIE report here.

According to the Korea Times:

Dr. Stephen Linton, founder of the Eugene Bell Foundation, says his group’s program to combat multidrug resistant TB (MDRTB) has cured its first patients after four years of working to establish adequate care in the North.

“We’re making progress,” Linton, 60, said in a phone interview. “It has been a tremendous learning curve for the North Koreans on a very short time frame. It takes most nations decades to put together a good MDRTB program because the treatment is so intensive.”

A growing health concern worldwide, MDRTB emerges when regular TB is inadequately treated, creating bacteria resistant to first- and sometimes second-line drugs. Half of those who do not get treatment, which can take up to two years to complete, die.

The problem is compounded in poor countries not properly equipped to diagnose the disease and where malnutrition makes the body more susceptible to TB.

The organization’s hopeful outlook follows its most recent trip to the North in November last year, when it found a steadily-increasing rate of patients testing negative for the strain ― meaning they are no longer infective.

It also comes as the international community wrestles with how to help the impoverished country ― which has called in recent weeks for humanitarian assistance ― without supporting its provocative behavior.

In the case of treating MDRTB, the doctor says the breakthrough would be impossible without meaningful contributions on both sides of the tense border that divides the Koreas.

Powerful medicine

By 2007, Linton had been travelling to the North to treat TB for more than a decade, so he was braced for the news when caregivers complained that first-line drugs were not helping some patients.

“I knew it was going to be a real headache,” he said of the undertaking. “But the commitment of our donors and the desire to treat the people in most need ― that was a powerful incentive.”

Later that year, Linton and his team took sputum from 19 patients, brought the samples to a South Korean hospital for analysis, and returned six months later with medicine. On subsequent trips, the number of patients wanting the test grew.

By 2009, as an indication of the worsening health situation but also the growing trust in the program, Eugene Bell was overwhelmed by crowds of people at its testing centers.

The program now accommodates upwards of six hundred patients at six specialized centers across the country’s northwest.

Linton, who spent his childhood in South Korea, says the process requires significant “buy-in” from North Koreans, beginning with the health authorities.

In their biggest show of cooperation, the government agreed to Eugene Bell’s recommendation that treatment take place in centrally-located MDRTB centers, despite reluctance over the logistics.

It also needs the dedication of health care providers, who must vigilantly keep patients on their programs. If not, they can become resistant to MDRTB medications, opening the door for the emergence of XDRTB, which Linton calls “virtually incurable.”

But the biggest commitment comes from patients, who are prescribed with a harsh cocktail of drugs. Some need to learn to trust outside help, not always an easy task in the isolated country.

“This is a very rigorous and rough treatment program. It takes a lot of very strong, toxic medicines to treat MDRTB. Patients suffer a good bit,” said Linton, who counted nausea, vomiting, temporary deafness and psychosis as side effects.

If after eighteen months, a patient’s sputum tests negative for MDRTB, they are effectively cured. But if after a year they still test positive, the treatment is considered a failure.

“Most of those people know, because they are still coughing up phlegm,” the doctor said. “But failing people is terrible. This work can be very dramatic at times.”

You can read previous posts about the Eugene Bell Foundation here.

UPDATE: On February 24th the Korea Economic Institute held a conference with Dr. Sharon Perry, DPRK Tuberculosis Project, Stanford School of Medicine.  You can see the video of the conference here: Part 1, Part 2, Part 3, Part 4. The paper is here (PDF).

Read the full sotry here:
Aid group engages N. Korea in fight against TB
Korea Times
Kim Joung-jin
2/21/2011

UPDATE: According to Yonhap:

A group of five South Koreans on Tuesday crossed the heavily armed border into North Korea, an official here said, delivering 400 million won (US$340,000) worth of anti-malaria aid despite tension between the divided states.

The crossing marked the first South Korean civilian visit to the communist state since Seoul banned trips to North Korea three months ago in protest over the sinking of a South Korean warship in March near their Yellow Sea border.

A doctor and four others, including two drivers, traveled to the North Korean border city of Kaesong on Tuesday morning, Unification Ministry spokesman Chun Hae-sung told reporters. The doctor was needed to explain to North Korean authorities how to use the aid kits, Chun said earlier this week.

ORIGINAL POST: According to Yonhap:

South Korea will allow a doctor to travel to North Korea next week in the first approval of a civilian visit on a humanitarian mission to the communist state since Seoul banned exchanges with Pyongyang in May over the sinking of a South Korean warship, an official said Friday.

The doctor, accompanied by two drivers, will visit the North Korean border town of Kaesong next Tuesday, Unification Ministry spokesman Chun Hae-sung told reporters in a briefing. The group is transporting 400 million won (US$336,100) worth of anti-malaria aid from a civilian relief group, Chun said.

“The doctor’s visit has been granted because he needs to explain to the North how to use the aid kits,” he said, adding any spread of malaria in the North has the potential to affect South Korean residents south of the border.

Read the full story here:
S. Korea to allow rare civilian visit to N. Korea amid tension
Yonhap
Sam Kim
8/13/2010

According to the Joong Ang Daily:

The northern Gyeonggi area, sharing the border with North Korea, is vulnerable to malaria because the mosquitoes with malaria parasites come from the North. Without vector controls in North Korea, our quarantine efforts are limited.

The spread of malaria had been expected because South Korea has stopped all North-bound shipments of aid, including pesticides and malaria drugs, as part of the sanctions against North Korea following its attack against the naval vessel Cheonan in March.

Health authorities warned in April about a possible breakout of malaria along the border regions. Although they saw the disease coming, nothing could be done about it.

On June 24, the Unification Ministry belatedly permitted a local civilian group to send quarantine aid to North Korea, but shipments have not taken place because of procedural difficulties. Even if the aid is delivered, it will be too late to contain the disease. Any action should have taken place before May.

If the Unification Ministry had seriously considered preventing the spread of malaria from the North, it should not have stopped at approving a delivery of local aid, but instead should have sought support from international groups. From 2001 to last year, the government had been shipping anti-malaria supplies to North Korea via the World Health Organization. This aid protects our people as much as it does North Koreans.

Malaria is not the only adverse result from severed ties with North Korea. The government announced on May 24 that it would cease all inter-Korean trade.

The measure, though understandable, dealt a heavy blow to 800 small- and mid-sized companies whose business primarily involves trade with North Korea. It was motivated by revenge and generated the same adverse fallout as that suffered by the people who have been infected by malaria from the North.

The tardy response to the problems created also proved of little help. The government on July 26 announced it will offer special aid loans to the Kaesong firms to save them from possible bankruptcy. The loans, though cheaper than regular corporate loans, will nonetheless have to be repaid and it may have come too late.

The May announcement of sanctions against North Korea should have included help to our companies to compensate for the damage from the trade sanctions.

Read the full story here:
Hard-line policies affect us, too
Joong Ang Daily

http://joongangdaily.joins.com/article/view.asp?aid=2924376

Cho Dong-ho
8/10/2010

UPDATE: UN World Health Organization has criticized the Amnesty report.  According to the Associated Press:

The World Health Organization found itself Friday in the strange position of defending North Korea’s health care system from an Amnesty International report, three months after WHO’s director described medicine in the totalitarian state as the envy of the developing world.

WHO spokesman Paul Garwood insisted he wasn’t criticizing Amnesty’s work, but the public relations flap illustrated an essential quandary for aid groups in unfree states: how to help innocent people without playing into the hands of their leaders.

Amnesty’s report on Thursday described North Korea’s health care system in shambles, with doctors sometimes performing amputations without anesthesia and working by candlelight in hospitals lacking essential medicine, heat and power. It also raised questions about whether coverage is universal as it — and WHO — claimed, noting most interviewees said they or a family member had given doctors cigarettes, alcohol or money to receive medical care. And those without any of these reported that they could get no health assistance at all.

Garwood said Thursday’s report by Amnesty was mainly anecdotal, with stories dating back to 2001, and not up to the U.N. agency’s scientific approach to evaluating health care.

“All the facts are from people who aren’t in the country,” Garwood told reporters in Geneva. “There’s no science in the research.”

The issue is sensitive for WHO because its director-general, Margaret Chan, praised the communist country after a visit in April and described its health care as the “envy” of most developing nations.

Major global relief agencies have been quietly fighting for years to save the lives of impoverished and malnourished North Koreans, even as the country’s go-it-alone government joined the exclusive club of nuclear weapons powers and wasted millions on confrontational military programs.

Some groups may fear being expelled from the country if they are openly critical of Pyongyang, which is highly sensitive to outside criticism. Still, Chan’s comments were uncommonly ebullient.

Garwood and WHO spokeswoman Fadela Chaib insisted that Amnesty’s report was complementary to their boss’ observations, and sought to downplay Chan’s praise for North Korea. Instead, they focused on the challenges she outlined for North Korea, from poor infrastructure and equipment to malnutrition and an inadequate supply of medicines.

But whereas Chan had noted that North Korea “has no lack of doctors and nurses,” Amnesty said some people had to walk two hours to get to a hospital for surgery. Chan cited the government’s “notable public health achievements,” while Amnesty said health care remained at a low level or was “progressively getting worse.”

Asked Friday what countries were envious of North Korea’s health, Chaib said she couldn’t name any. But she highlighted the importance of maintaining the health body’s presence in the country, where officials do their best to save lives despite “persisting challenges.”

“We are an organization dealing with member states, and we respect the sovereignty of all countries,” Chaib said. “We need to work there to improve the lives of people.”

Sam Zarifi, head of Amnesty’s Asia-Pacific program, said the human rights group stood by its findings.

“We certainly have a lot of restrictions in terms of working in North Korea, but we did our best in terms of capturing the information we could verify,” Zarifi said. “We don’t take the WHO’s statements as criticizing or rejecting Amnesty’s findings.”

He said Amnesty had spoken to North Koreans as well as to foreign health care and aid workers, and relied heavily on WHO for information — including the assessment that North Korea spends $1 per person per year on health care, the lowest level in the world.

The U.N. estimates that 8.7 million people need food in North Korea. The country has relied on foreign assistance to feed much of its population since the mid-1990s when its economy was hit by natural disasters and the loss of the regime’s Soviet benefactor.

North Korea, ruled by Kim Jong Il, is routinely described by U.N. and other reports as one of the world’s most repressive regimes.

Garwood said Amnesty’s research added a needed element to understanding health conditions in North Korea, but added that it didn’t even mention recent improvements in the country as the result of a program funded by South Korea and aided by WHO.

The U.N. body claims that maternal mortality has declined by over 20 percent since 2005, and diarrhea cases and deaths in operations have also dropped. It says more than 6,000 doctors and nurses have been trained in emergency obstetric care, newborn care and child illnesses, while clinics have received better material for operations, blood transplants and other medical interventions.

As for Chan’s April claim that “people in the country do not have to worry about a lack of financial resources to access care,” Garwood said hundreds of field missions have been conducted in North Korea.

“None have come back reporting the kinds of things in the Amnesty report in terms of payment for services,” he said.

“I’m not saying they’re not credible accounts,” he added. “But it’s not taking into account some of the things that are happening today.”

Zarifi, of Amnesty, said the whole debate would be ended if North Korea’s government provided access to monitors so that everyone had a better understanding of the country’s health care system.

“Every indication we have indicates the state of health care in North Korea is dire,” he said.

ORIGINAL POST: Here is the introduction to the report (which you can download here as a PDF):

In the early 1990s, the Democratic People’s Republic of Korea (DPRK or North Korea) faced a famine that killed up to one million people in a population that at the time hovered around 22 million (the current population stands at 23.9 million). Food shortages and a more general economic crisis have persisted to this day. The government has resolutely maintained that it is committed to, and capable of, providing for the basic needs of its people and satisfying their right to food and a proper standard of health. The testimonies presented in this report suggest otherwise. The people of North Korea suffer significant deprivation in their enjoyment of the right to adequate health care, in large part due to failed or counterproductive government policies. These poor policies include systematic failure to provide sufficient resources for basic health care (North Korea had one of the lowest levels of per capital funding for health care recorded by the World Health Organisation in 2006). After nearly two decades, food insecurity remains a critical concern for millions of North Koreans. This has been compounded by the government’s reluctance to seek international cooperation and assistance, which the government is obligated to do when it would otherwise be unable to ensure minimum essential levels of food for the whole population, and its restrictions on the delivery of humanitarian assistance. This delayed and inadequate response to the food crisis has significantly affected people’s health.

Additionally, a currency revaluation plan in November 2009 caused spiralling inflation that in turn aggravated food shortages and sparked social unrest. In the first few months after the plan went into effect, the North Korean government exacerbated the situation by restricting the use of foreign currency, closing down food markets, and prohibiting small-plot farming. Many people died of starvation and many others lost their entire savings.

Amnesty International has documented how widespread and chronic malnutrition, which suppresses people’s immune system, has triggered epidemics and mass outbreaks of illnesses related to poor diet. Interviews with North Koreans depict a country that professes to have a universal (free) health care system but in reality struggles to provide even the most basic service to the population. Health facilities are rundown and operate with frequent power cuts and no heat. Medical personnel often do not receive salaries, and many hospitals function without medicines and other essentials. As doctors have begun charging for their services, which is illegal under North Korea’s universal health care system, the poor cannot access full medical care, especially medicines and surgery.

The interviews conducted by Amnesty International indicate that the North Korean government has also failed its obligation to provide adequate public health information. As a result, most of the interviewees were unaware of the importance of seeking proper medical diagnoses or completing a course of medication. And, because many hospitals no longer supply free services or medicines (despite government commitments to the contrary), many people normally do not visit doctors even when they are ill.

In a 2004 report, Starved of Rights: Human rights and the food crisis in the Democratic People’s Republic of Korea (North Korea), Amnesty International documented actions of the North Korean government that aggravated the effects of the famine and the subsequent food crisis, including denying the existence of the problem for many years, and imposing ever tighter controls on the population to hide the true extent of the disaster from its own citizens. It also documented the government’s refusal to allow swift and equitable distribution of food and its imposition of restrictions on freedom of information and movement, which exacerbated the population’s ability to search for food.3 Although some progress has been made since 2004, access to food is still a critical issue in North Korea. As this report demonstrates, the inadequate and sometimes counter-productive actions of the North Korean government over the country’s food crisis have had a devastating impact on the health of the population.

Under international law and standards, North Korea is obligated to protect the rights of its population to the highest attainable standard of health. This means that, at the very least, the state must provide for adequate health care and the underlying determinants of health, including food and nutrition, housing, access to safe and potable water and adequate sanitation, safe and healthy working conditions, and a healthy environment. North Korea’s responsibilities under international and domestic law will be addressed in greater detail in section 5.

To improve the situation, Amnesty International presents the following key recommendations to the government of the Democratic People’s Republic of Korea with more detailed recommendations in the conclusion of this report.

Amnesty International calls on the North Korean government to:

1. as a matter of priority, ensure that food shortages are acknowledged and effective steps taken to address these shortages, including acceptance of needed international humanitarian assistance;

2. ensure the need-based and equitable distribution of health facilities, goods and services throughout the country;

3. co-operate with the World Food Programme and donors, allow unrestricted access to independent monitors, and ensure non-discrimination, transparency and openness in the distribution of food aid;

4.ensure that medical personnel are paid adequately and regularly so that they may carry out their duties properly;

5. undertake information and education campaigns to provide accurate and comprehensive information on prevalent infections and diseases; their causes, symptoms and treatment; and the importance of medical diagnosis and effective use of medicines.

Furthermore, Amnesty International recommends to the international community, and in particular, major donors and neighbouring countries such as China, Japan, Russian Federation, South Korea and US to:

1. ensure that the provision of humanitarian assistance in North Korea is based on need and is not subject to political conditions.

This report has received wide coverage in the media.  Here are the links:

Barbara Demick, Los Angeles Times

Choe Sang-hun, New York Times

Yonhap

BBC