North Korean Economy Watch

Korea Times
Lee Jin-woo
5/23/2007

A middle-aged American doctor who grew up in South Korea has stressed that it’s time to move on to helping North Korea with public health issues.

“North Korea’s food situation is at least better. We need to move on to public health issues including rebuilding the North’s nine provincial and 200 county hospitals,” John A. Linton of Yonsei University’s Severance Hospital in Seoul told The Korea Times in an interview on Monday. The 47-year-old doctor heads the hospital’s international health care center.

Linton, who is well-known for his Korean name Yin Yo-han and thick South Jeolla Province accent, proposed a three-stage medical support program for North Korea from the South Korean government.

“Number one, we need to help them with a vaccination program, which should be followed by supplies of diagnostic equipment,” he said. “The final stage should be an exchange of doctors between the two Koreas.”

He said North Korean doctors need basic diagnostic equipment _ ultrasound and x-ray machines, and clinical pathology supplies _ as well as more operating theaters.

“You have to have a healthy population in the North, for them to survive and become competitive enough to receive economic finance and business opportunities.”

He hoped that large-scale medical support to the North on a regular basis would be discussed during ministerial talks between the two Koreas in the near future.

“Nobody can argue with health care,” he said. “North Korea has been an enemy, but now at the same time they are brothers. Even if they are an enemy, you must help them.”

Linton, who visited the North 17 times between 1997 and 2003 to help eradicate tuberculosis in the Stalinist state, said it should be South Korea, not the United Nations or the World Health Organization (WHO), that needs to take the lead in helping the North.

“You have to be very, very careful with the U.N. and WHO. They treat the two Koreas as two separate countries differently,” he said. “Eventually policy should be looking towards unification. South Koreans should take the lead.”

Asked whether he is a big fan of South Korea’s engagement policy toward Pyongyang, dubbed the `Sunshine policy,’ he said he supports it wholeheartedly. Linton, however, emphasized the need to guarantee transparency in the process.

“We should not encourage some of the North Korean leadership as middle management is very corrupt. We should not reward corrupt people there. That’s not for us that’s for North Korea.”

His dedication toward helping the North was initiated by his mother, who worked to eradicate tuberculosis in Suncheon in South Jeolla Province for some 40 years. She decided to donate ambulances to North Korea in 1997.

“When we got there in Pyongyang, we suddenly received a special request from North Korea asking for assistance treating TB throughout the whole country,” he said. “We visited the entire country while helping them fight TB.”

In his autobiography published last year, Linton recalled his unforgettable experiences as an interpreter during the bloody Kwangju pro-democracy movement in May 1980.

He served as a translator to people who occupied the provincial capital against the then military regime led by former President Chun Doo-hwan.

“Immediately following this experience, I was labeled as an insurgent ,” he said. “The American embassy in Seoul asked me to leave Korea, just for translating for three to four hours for reporters.”

He said his experience in Kwangju changed his personal life and made him understand what injustice is and how dangerous newspapers are.

He said such a great sacrifice should never ever happen again on the Korean Peninsula.

AFP
Philippe Agret
5/21/2007

After being ravaged by famine in the 1990s, North Korea again faces serious food shortages, with a UN official based here saying that politics are making things worse.

On the road from the capital Pyongyang to Kaesong in the south, every hill lot is developed for agriculture, with all farm work done by hand.

But only 17 percent of the land in North Korea is arable, one of the lowest ratios in the world, according to the UN’s World Food Programme (WFP).

“North Korea is suffering a chronic food shortage due to structural problems and limited food imports and food aid,” said Jean-Pierre de Margerie, the WFP’s representative in the communist state.

He lamented the international community’s lack of commitment to North Korea amid the deadlock in six-nation talks on disarming Pyongyang, and what some consider to be “hidden sanctions” linking a large part of aid to politics.

“There is no evidence that holding back food or humanitarian aid destined to civilian populations would have an impact on the government or its behaviour,” he said.

North Korea’s worst period came from 1995 to 1999 when drought, flooding and the disappearance of Soviet aid led to a famine that killed between 800,000 and two million people, according to independent estimates.

The scars of the famine still run deep, with a 2004 United Nations study finding that 37 percent of North Korean children suffered chronic malnutrition.

Some experts use the term “7, 8, 9, 10” — as an adult, a seven-year-old born during the famine will be eight kilograms (18 pounds) lighter, stand nine inches (23 centimeters) shorter and live 10 years less than a South Korean of the same age.

The groups most at risk are young children and women who are pregnant or breastfeeding.

After a record harvest in 2005, 2006 was “very difficult” due to heavy floods in the summer and a dramatic drop in food aid and food imports; 2007 could also be dire, de Margerie warned.

Amid the international furore over Pyongyang’s nuclear and missile tests last year, China reduced its aid by half and        South Korea temporarily halted shipments.

Seoul has since resumed fertiliser aid and promised to provide 400,000 tons of rice to North Korea starting in late May.

But the food aid is linked to political conditions, such as Pyongyang shutting its nuclear reactor in line with a multilateral disarmament deal reached in February.

The impoverished country faces a shortfall of one million tons of food this year, or 20 percent of its needs, according to the WFP and the UN’s Food and Agriculture Organisation.

Up to one third of North Korea’s 23 million people may need assistance ahead of the next harvest, warns the WFP.

So is there a danger of another famine?

“No, not yet,” said de Margerie. “But if the trend continues, pockets of severe malnutrition could develop.”

In Pyongyang, not everyone is pessimistic as there is a lack of reliable agricultural data. Some observers say the problems lie in the distribution system and access to food, rather than in actual production.

North Korea’s leaders — whose ruling motto is “juche,” or self-reliance — say they have made food security their priority, but Pyongyang has nonetheless relied on foreign help.

The WFP has collected two billion dollars in 10 years, supplying four million tons of food between 1995 and 2005 that assisted one-third of North Korea in its biggest operation at the time.

Since 2001, multilateral aid from the WFP has been gradually replaced by assistance from China and South Korea. While bilateral aid goes to the government and may be distributed to the elite, the WFP says it closely monitors its aid so that it reaches those most in need.

This year, donor countries have promised only 12,000 tons of food.

The WFP has received only 20 percent of the financing for its programme up to March 2008, assisting three percent of the population, or 600,000 people, instead of the initial objective of reaching nearly two million North Koreans.

De Margerie says he hopes the international community will set aside political concerns to focus on the human tragedy unfolding in North Korea.

“You only see negative images of North Korea. But it has a human face,” he stressed.

“An eight-month-old child or pregnant woman does not engage in politics. It’s the most vulnerable in the civilian population who pay the price.”

Daily NK
Han Young Jin
5/21/2007

Well-informed sources say Heungnam manufacturer’s production facility shuts down.

Several well-known sources relayed on the 20th that as North Korean drugs flow into China in large amounts, it strongly protested to North Korea and requested that the Heungnam Pharmaceutical Manufacturer in Hamheung be shut down.

Following suit, the North Korean government authorities was known to destroy the Heungnam Pharmaceutical Manufacturer used in producing bingdu (the alias for “ice” classified in the category of Philopon in North Korea).

The well-informed source said, “China’s judicial authorities are strongly coping with the situation by imposing three years of penal servitude to those who sell 10g of Bingdu (so called “Ice” in North Korea) or a penalty of 20,000 yuan. When North Korea demonstrated a lax response, China expressed strong discontent.”

In North Korea, the Nanam Pharmaceutical Manufacturer in Chungjin, North Hamkyung is famous as a representative drug manufacturing company. The source evaluated that Hamheung, which has recently risen as a drug production base, had weak means of living which produced the highest number of deaths during the 90s’ mass starvation and the stimulant “Ice” was misused due to the lack of medical products.

$3,000 per kilogram…dealt for $10,000 at the border

An internal source said, “During the March of Suffering, a part of citizens who even sold raw materials and factory equipment earned big money by selling drugs. Since then, everyone has followed the trend. The people in Hamheung started handling drugs with great ambition due to the fact that at the Heungnam Pharmaceutical Manufacturer, the prime cost for a kilogram is $3,000 dollars and the profit exceeds $5,000.”

The source said, “In the past, people touched drugs hoping to make a big fortune with a single swoop, but everyone is thinking about making money by selling drugs nowadays. Inevitably, the number of civilians who have become ‘ice’ addicts has significantly increased.”

Ice can be produced for $3,000 per kilogram and sold on site for $7-8,000 and at the border region where smuggling is possible, it can be sold for up to $10,000.

Another source said, “Civilians have fallen to the bedazzlement of making a jackpot with drugs, so they have gone to the border region carrying drugs and seeking dealers. However, fakes that have been manufactured ingeniously are also making a wave.”

In North Korea, as drug sales have been unyielding, it was known that teenagers who are touching “ice” are not only seriously in Hamheung but in all regions. They are not showing immediate signs of addiction, but they can be presumed as “high-risk” people for addiction.

North Korean businessman Mr. Kim, who is engaging is trade between North Korea and China, wore a sorry expression and said, “Nowadays, children who are not yet fully grown use ‘ice.’ Not too long ago, my friend’s 12-year old son was found while secretly using his father’s ‘ice.’ After severely beating him, the father asked, “Do you like ‘ice’ so much? The son responded, ‘it is a cure-all.’”

In the mid-1990s, due to deteriorated medical facilities and a shortage of medical goods, citizens started to depend on folk remedies. Civilians who started using ‘ice’ in lieu of cold medicines started using it as emergency medicine even for the flu and strokes.

Mr. Kim said, “Ice has a stimulant quality, so it is used to as a stimulant and a stress-releaser. Even children have come to regard it as a panacea and think that a little suck of ice will instantly get rid of pain and make one refreshed.”

Narcotic squads hardly have any strength

The North Korean authorities issued a narcotics degree in March of last year to prevent drug abuse. It has even issued the threat of putting to death related parties of drug deals. However, businesses that have earned money through drugs feed bribes to inspection organs, so sources said that these institutions cannot exert any strength.

One domestic source said, “Recently, a Central Party inspection group was organized in Shinuiju and came forward to regulate drugs, but authorities such as the National Security Agency, the National Security Office, and others have become implicated. However, exposing them in increasing measures makes punishment difficult, because complicit individuals can come forward in hordes.”

Drug sellers in the border region have divided left-over profits from handing over to China with participating National Security officers. The source said, “If a drug dealer is arrested, if back-money is given, even the ring-leader will be immediately released.”

The source also said that upper-class drug inspection groups can instantly become conspirators due to the high amount of money to be handed over to their superiors.

KCNA
5/21/2007

The Sokthang hot-spring in Onjong-ri, Yangdok County, South Phyongan Province is one of the famous spas in Korea.

Hot spring gushes from different places in three zones and the temperature of the water is 78 degrees centigrade.

The water contains mineral matters, hydrogen sulphide, metasilicic acid component, hydrogen carbonate ions and sodium ions.

As it regenerates skin, promotes blood circulation and heals inflammation, the water is applicable to the treatment of various diseases including chronic osteoarthritis, neuritis, neuralgia, sequelae of traumatism and operations and women’s troubles.

Nearly 50 years ago, a facility was built there for medical treatment with the hot-spring as the main, which was developed into Sokthang Hot-Spring Sanatorium, a medical institution for special treatment of skin diseases.

The sanatorium has mineral-water treatment rooms for bath, shower and rectoclysis, a physiotherapy room for high-frequency treatment and ultrasonic therapy, a functional treatment room for curative sports and massage and so on. It helps promote the people’s health.

Eugene Bell Foundation (Hat tip D.”S.”B.)
207 C Street, SE, Washington, DC 20003   
TEL: 202-393-0645   
FAX: 202-543-2390
For more information:
Alice Jean Suh; alice@eugenebell.org;
+1-202-329-2410

EugeneBell Returns from 2007 Spring Visit to North Korea Initiates Maternal and Infant Care and Children’s Care Programs

The Eugene Bell Foundation earlier this month visited 17 medical institutions in the Democratic People’s Republic of Korea (North Korea) and launched two groundbreaking community health projects targeting the country’s most vulnerable groups: new mothers and infants, and school-aged children.  From May 1-12, EugeneBell’s chairman, Dr. Stephen Linton, and four delegation members visited city, district, and county medical institutions in North Korea’s South Pyongan Province. All 17 institutions received shipments of assistance as part of EugeneBell’s Partner Package Program 

New Maternal and Infant Care Program and Children’s Care Program

EugeneBell confirmed the new programs’ first deliveries of instructional materials, equipment and supplies at two local hospitals in Sunchon and Anju, cities in South Pyongan Province. These new programs will be implemented in three steps to ensure transparency. Our delegation received agreements from the medical staff at both institutions to implement the first step, with the understanding that progress to the second and third steps will require proof of adherence to EugeneBell’s standards on further visits. These new programs signify groundbreaking advances in EugeneBell’s work. In addition to providing training, equipment and supplies for entire institutions, these programs have also tailored assistance to individual patients. For the first time, EugeneBell will partner with doctors at the most basic level of care in North Korea’s system. All citizens in North Korea are assigned family care physicians. EugeneBell’s new programs will strengthen the ability of family doctors to treat individual patients more effectively and transparently.  “I am very excited about this new opportunity to help insure that pregnant women receive the best care possible from early pregnancy through child-birth,” said Dr. Linton. “We hope to help North Korean caregivers manage child health from the womb all the way through grade school, the most critical period for human development.”  The initial phase of these two new programs received an enthusiastic welcome from hospital staffs. EugeneBell plans to extend this effort to other local hospitals as funding becomes available.

Equipment and Training Upgrades for Local Hospitals Dramatically Improve Local Healthcare

During this visit the delegation was able to evaluate the effectiveness of a program to upgrade diagnostic and surgical capacity at seven out of 40 plus medical facilities supported by EugeneBell. The delegation was impressed at the level of technical sophistication achieved by North Korean caregivers after receiving comprehensive training manuals last year. Through self-study North Korean technicians had, in a surprisingly short time, mastered the use of complex diagnostic equipment and had even made minor repairs.  “It was very impressive,” said Dr. Linton, “to see North Korean technicians operating advanced equipment previously unfamiliar to them. More impressive was the level of cooperation between hospitals that had received the same equipment. When we first started this program, these hospitals were empty because patients had little hope of receiving adequate treatment.  Now that they have new equipment, previously empty hospitals are filled to capacity. Patients wait in line to be examined by the new equipment. “It’s worth the effort to watch these hospitals come back to life.”

Support for Children with Tuberculosis

On this visit the delegation found a new emphasis on treating children with tuberculosis. Several new children’s wards have been established to provide better care for young patients in South Pyongan Province, Nampo City and Pyongyang City. Children are particularly at risk of tuberculosis when their immune systems are weakened by poor nutrition. In response to the new emphasis on childhood tuberculosis by North Korea’s health authorities, EugeneBell will include a system for providing assistance directly to young patients this fall.

Medical Institutions Visited

During May 1st – 12th EugeneBell visited 17 North Korean medical institutions in: South Pyongan Province and Nampo City, South Pyongan Province Tuberculosis Hospital (TBH), Children’s Ward-South Pyongan TBH, South Pyongan Province Children’s Hospital, Anju City Tuberculosis Care Center (TBCC), Pyongsong City TBCC, Bukchang County TBCC, Sunchon City TBCC, Daean County TBCC, Ryonggang County TBCC, Anju City People’s Hospital, Sunchon City People’s Hospital, Daean County People’s Hospital, Chollima County People’s Hospital, Nampo City TBH, Nampo City TBCC, Waudo District People’s Hospital, Hanggu District People’s Hospital 

Total Results of Support in Spring 2007: $ 1,793,717.21 This spring EugeneBell shipped a total of $1,793,717.21 worth of medical goods to 45 medical institutions in North Pyongan Province, South Pyongan Province, Pyongyang City and Nampo City.  

EugeneBell in Action

1. New mother and infant at the Anju City People’s Hospital, part of EugeneBell’s new Maternal and Infant Care Program.

2. Children in Anju City being given health physicals, part of EugeneBell’s new Children’s Care Program.

3. Grade school students are examined at a mobile X-ray vehicle donated through EugeneBell to Nampo Tuberculosis Hospital.

4. Dr. Linton interviews a young patient at the Children’s Tuberculosis Ward at Nampo Tuberculosis Care Center.

5. A patient is examined with a sonogram donated through EugeneBell at Daean People’s Hospital.

   
6. Dr. Linton (left) delivers medical supplies and equipment to Chollima People’s Hospital in South Pyongan Province. In the spring of 2007 EugeneBell shipped almost 1,800,000 dollars of medical assistance to 40 odd medical facilities.

7. Through EugeneBell donors sent 2,200 sets of Patient Necessities Kits to long-term patients in sixteen tuberculosis care centers. EugeneBell does everything possible to identify donors to recipients.

Bloomberg
Bradley Martin
5/16/2007

For decades, tourists visiting North Korea have been brought to a 200-room, 70,000-square-meter palace completed in 1978 that displays presents to Kim Il Sung, the “Great Leader,” who died in 1994.

Starting with Joseph Stalin’s 1945 gift of a bulletproof railway carriage, the items include a stuffed bird from American evangelist Billy Graham and a piece of the Berlin Wall donated by a German writer.

These days most visiting foreign dignitaries bring gifts for Kim’s eldest son and successor, Kim Jong Il, 65. The junior Kim’s loot is housed in a 20,000-square-meter (215,278-square- foot) annex that was completed in 1996 — a time when a famine was starving tens of thousands of North Koreans.

Why would the country have spent vast sums on four-ton bronze doors and polished marble floors? “Our people couldn’t display all these precious gifts in a poor palace,” says tour guide Hong Myong Gun. “So we built this palace with our best.”

The gifts in the windowless “International Friendship Exhibition” at Mt. Myohyang, a two-hour drive north of the capital, Pyongyang, range from the trivial to the grandiose.

Cable News Network founder Ted Turner donated paperweights with the CNN logo. A tribal chief in Nigeria offered a throne featuring carved lions, with matching crown and walking stick. Romanian communist dictator Nicolae Ceausescu brought the stuffed head of a bear he had hunted and killed.

Giving and Receiving

In Asia, the protocol of gift-giving has been well established since Chinese emperors began expecting visitors to bear tribute. The Chinese know how to give as well as to receive: Pride of place in the exhibit goes to one of their presents, a life-sized wax figure of Kim Il Sung standing on a three-dimensional representation of a lake shore.

Reverent music, calculated to induce bowing, plays in the background of the posthumous gift, the final exhibit viewed by visitors to the hall.

The elder Kim’s title of President for Eternity makes him the world’s only dead head of state, and Hong says he continues to receive gifts. As of last year, his presents numbered 221,411.

“No other president could draw so many presents, so our people live in pride,” she says. “Except for this place, where can you see such a sight?”

The annex for Kim Jong Il, whose titles include secretary general of the Workers’ Party and chairman of the Military Commission, houses 55,423 additional presents, Hong says. As with his father’s gifts, most of them were never used but were immediately donated to the exhibition.

A Dynasty Sedan

Some highlights in the annex: a 1998 luxury sedan from the founder of South Korea’s Hyundai group — the model named, appropriately enough, Dynasty — and two roomfuls of carved, gilded furniture from South Korea’s Ace Bed Co.

From time to time, groups of uniformed soldiers troop past to see the gifts. A high percentage of them are five feet tall or shorter. In the 1990s, North Korea reduced the minimum height for military service to 148 centimeters (4 foot 9 inches) from 150 centimeters and the minimum weight to 43 kilograms (95 pounds) from 48 kilograms, according to South Korea’s National Intelligence Service.

A 2004 World Food Program nutritional survey found that 37 percent of North Korean children suffered chronic malnutrition. The state “bears central responsibility” for the shrinking of North Koreans, says Marcus Noland of Washington’s Peterson Institute for International Economics, co-author of a new book about the famine.

Freeing Up Foreign Exchange

“As aid began arriving, the North Koreans cut commercial food imports, freeing up foreign exchange,” Noland said in an e-mail exchange.

The saved money was used to purchase surplus military aircraft from Kazakhstan and to build monuments “to the recently departed Great Leader Kim Il Sung and his son,” Noland says. If the regime had maintained the rate of commercial food imports during the 1990s, using aid as a supplement instead of a substitute, he says, “the famine could have been avoided.”

Noland estimates the death toll at 600,000 to 1 million; others have said as many as 4 million people may have died.

Tour guide Hong, 27, places the blame elsewhere. “From 1993 to 2000 our people suffered from countless natural disasters and also from other pressure in the economic field owing to the U.S. aggressors,” she says, referring to sanctions. Even during such hardships, she says, constructing the annex with the best materials was “the greatest desire of our people.”

As she speaks, there is a brief power blackout, a frequent occurrence in the energy-short country. When the lights come back on, Hong continues.

“Our people are very grateful because the Great Leader Kim Jong Il sent all the gifts here for the people to look at freely,” she says. “It was our duty to preserve them and show them to the new generation.”

Daily NK
Han Young Jin
5/9/2007
“If you have a second child, your rations become equivalent to a family of 4”…citizens respond apath 
 
North Korean authorities have been scrutinizing over the decreasing number of birthrates by young couples and as a result have proposed to increase the amount of rations to families having children.

If a couple gives birth to a second child in the district of Hamheung, South Hamkyung, the whole family will receive 6 months worth of distributions, a source informed. If a third child is born, the rations increase all the more.

After giving birth to a child in a hospital, a married woman from Hamheung can obtain a birth certificate, which is then submitted to the local district office, to receive distributions equivalent to a family of 4. These proposals resemble policies implemented by local district offices in South Korea.

Though Hamheung city has made efforts to increase the birthrate with distributions, the people’s response is all but cold, the source said. How many people would really have a second child just to scavenge off a few months worth of distributions.

One of the main reasons that the birthrate is decreasing in North Korea is due to the fact that women are avoiding giving birth, informed the source.

The source said, “Nowadays, North Korean women engage in businesses and are the breadwinners of the family. They are not satisfied with just having children and bringing them up” and added, “Everyone knows that it is hard enough to live and even harder if you have a lot of children.”

North Korea’s birthrate has continued to decline since the late 1990’s. The average birthrate in North Korea in 1993 was 2.1 births per family and in 2002, 2.04. Comparatively, in South Korea the birthrate per family in 1970 was 4.53 and 1.19 in 2003. Within a period of 33 years, the number of childbirths per family had reduced to 3.34 persons.

In an interview with the Jochongryeon last December, Kang Nam Il, head of the North Korea Population Research Center said, “The decrease of birthrates in our country (North Korea) is no different to that of other nations” and remarked, “Women want to have 2 children, though in the cities women have either 1 or 2 children.”

The source said, “There may be slight differences in each district. Nonetheless, most of the larger cities have adopted this proposal” and added, “This policy was implemented as North Korean authorities are finding it difficult to reach the quota for conscription and the number of students enrolling in schools.”

KCNA
5/7/2007

Renovation work of sanatoriums in Kyongsong County of North Hamgyong Province, Samchon County of South Hwanghae Province, Thongchon County of Kangwon Province and other parts of the DPRK are progressing apace so as to deliver better medical service to people. 

The Kim Jong Suk Sanatorium has facelifted various buildings including the balneotheraphy building and furnished them with more convalescence and treatment facilities. 

In the Talchon Disabled Soldiers Sanatorium, the renovation project for the existing buildings including the general infirmary and the infirmary for disabled soldiers has been wound up and preparations for building 50 houses similar to rural dwelling houses are being made so that working people may lodge there and receive spa treatment. 

Besides, tens of sanatoriums including Chongsan Medicinal Spring Water Sanatorium and Naegok Spa Sanatorium across the country are changing their looks as the days go by.

Joong Ang Daily
5/3/2007

North Korea recently issued a new postage stamp on the prevention of bird flu, Choson Sinbo, a pro-Pyongyang newspaper published in Japan, reported yesterday.

“North Korea’s Stamp Company has been creating new stamps with world topics and urgent international issues. Among those is the avian influenza prevention stamp,” the newspaper said. “In North Korea, bird flu prevention measures have been conducted continuously as a national project.”

The newspaper quoted a North Korea Stamp Company official as saying, “This stamp was created to promote North Korea’s health policy and to warn the public about the need to be careful about the disease.”

The price of the stamp is 85 North Korean won.

In February 2005, bird flu outbreaks were reported in poultry farms near Pyongyang. Sources close to North Korea’s affairs have said more than 210,000 chickens have been slaughtered to contain the disease.

 AFP
 Philippe Agret
 5/2/2007

SARIWON, North Korea (AFP) – To cope with the pouring rain, the hospital tossed sawdust down the stairway leading to the operating theatre.

Two surgeons washed their hands in a sink, but sometimes they lack soap.

Much like the rest of North Korea, a political pariah and economic black hole, the nation’s hospitals subsist with whatever they can get their hands on, making ends meet with obsolete equipment, short-cut procedures and a smattering of foreign assistance.

Even by the standards of the developing world, the facilities here in Sariwon, a 45-minute drive south of the capital Pyongyang, leave much to be desired.

The medical equipment is largely German or Soviet, reused as long as possible, but spare parts are desperately lacking.

“As we lack sufficient or working equipment, we use local anaesthesia and acupuncture for operations,” said the director of the Sariwon hospital, Dr Choe Chol, a surgeon.

In winter, surgeons operate in rooms where the temperature is lower than five degrees Celsius (41 Fahrenheit).

To improve conditions, the doctors and nurses pitch in themselves to make the hospital work, sometimes even laying down the tiling in the operating theatres.

“We do our best here. There’s no bleach, no soap, no disinfectant. We cleanse with distilled water. It’s the volunteers — the doctors and nurses — who regularly do the cleaning up,” said Veronique Mondon, the North Korea head of the French charity Premiere Urgence.

Premiere Urgence is one of only six foreign non-governmental organisations allowed to work in the Democratic People’s Republic of Korea.

Like others NGOs, the group has set a goal of bringing the most basic treatment to the population — but also to encourage North Koreans to develop their own medical infrastructure.

Premiere Urgence’s primary effort has been producing intravenous drips — one of the only medical supplies made in North Korea — for the 12 hospitals where it works.

With 70 to 80 percent of the medicine in North Korea coming from overseas donations, the IV drip — in the form of a packet with a solution of distilled water, glucose and sodium — serves to ease the impact of the lack of supplies.

“These packets can be used for a great number of the medical problems in North Korea such as accidents, malnutrition, dehydration, diarrhea, typhus and hepatitis. They save lives,” said Mondon, a biologist who opened Premiere Urgence’s branch in North Korea in April 2002.

If IV drips are effective, their production is a daily challenge. The packets must be sterilised on site in the most sanitary conditions possible, a process that takes about three and a half hours.

In light of the instability of the electricity and frequent short power cuts, Premiere Urgence has brought in specially made transformers from China.

“The people in the laboratories work during the night to produce the packets so as to save the electricity for the sick people and operations during the day,” Mondon said.

“It was tough at first. It seemed to be an insurmountable task. But now, the North Koreans know that this is needed,” she said.

After the April 2004 disaster in the northern city of Ryongchon, when a cargo train blew up, killing more than 160 people and wounding a thousand others, Premiere Urgence worked round the clock to produce IV drips and distributed 40,000 of them to two hospitals that were treating victims.

Today, the laboratory in Sariwon produces 300 IV drips a day — enough to treat more than 200 patients in this 750-bed hospital.

Across North Korea, Premiere Urgence produces 500,000 packets a year, each one worth around 50 US cents.

The French group has also set up a central laboratory in Pyongyang for quality control over injectable solutions.

North Korea’s communist leadership adheres to the homegrown ideology of “Juche” — self-reliance and self-sufficiency.

But at least hundreds of thousands of people died in a famine in the 1990s and North Korea has since relied heavily on foreign assistance — notably for food — despite continued political defiance, including its test of an atomic device in October.

From the International Committee of the Red Cross (ICRC) to the few NGOs in North Korea, all encourage local initiatives in an effort to prevent a culture of dependence.

Premiere Urgence plans eventually to hand over the maintenance of equipment and training of technical staff to the North Korean ministry of public health.

As for the ICRC, as well as helping produce 1,200 prosthetic limbs in 2006, it has focused efforts on training local people, including orthopaedic specialists and surgeons.

“North Korea’s pharmaceutical industry will never be able to develop if humanitarian groups flood North Korea with foreign medicine. It will continue to vegetate and manufacturer substandard products if foreigners do not buy local medicine,” said Felix Abt, a Swiss businessman who heads PyongSu Pharma JV. Co Ltd., one of the first foreign joint ventures in North Korea.

Pyongsu has set up a “model” pharmacy in Pyongyang and since September 2004 has run a factory with 30 employees manufacturing paracetamol, the pain relief drug sold under name brands such as Tylenol, along with aspirin and antibiotics.

Abt hopes one day to be able to export medicine from North Korea.

“For now, we are giving the North Koreans fish. It would be better to give them nets so they can catch fish,” Abt said.