Amputation and other major surgeries carried out without anaesthesia are just one indication of the dire state of North Korea's healthcare system, a new Amnesty International report released today has found.

The Crumbling State of Health in North Korea (pdf 690kb) draws on interviews with North Koreans and health workers to paint a picture of barely-functioning hospitals void of medicines, epidemics brought on by malnutrition, and a generation of stunted children.

Even sterilising needles and washing sheets are described as beyond the country's failing health infrastructure.

"North Korea has failed to provide for the most basic health and survival needs of its people.  This is especially true of those who are too poor to pay for medical care," said Catherine Baber, Amnesty International's Deputy Director for the Asia-Pacific.

According to the World Health Organization's last available figures, North Korea spent less on healthcare than any other country in the world – just U.S.$0.5 per person per year in total.

The North Korean government still claims that its healthcare system is free for all, but in reality, payment has been required for all services since the 1990s, with doctors usually paid in cigarettes, alcohol or food for the most basic consults, taking cash for anything else, like tests or surgery.

The report found that many North Koreans bypass doctors altogether, going straight to the markets to buy medicine, self-medicating according to their own guesswork or the advice of market vendors.  It is common for North Koreans to take highly addictive narcotic painkillers for the common cold.

"This is especially worrying as North Korea fights a tuberculosis (TB) epidemic," said Catherine Baber.  "A growing number of patients have developed a resistance to first-line anti-TB drugs."

"The North Korean people are in critical need of medical and food aid," said Catherine Baber. "It is crucial that aid to North Korea is not used as a political football by donor countries."

Amnesty International is urging donor countries to continue providing humanitarian aid to North Korea through the UN, and to refrain from punitive actions that will endanger the North Korean people's right to life and health.

North Korea needs far more international assistance to improve its public health infrastructure. The UN World Food Programme (WFP) in North Korea is also grossly underfunded, needing more donor support and political backing.

Food shortages remain constant in North Korea.  After a botched currency revaluation in December 2009, the price of rice more than doubled and according to an NGO quoted in the report, thousands of people starved to death between January and February of this year in one province alone.

Many of the interviewees reported chronic health problems brought on by a lack of food, and had coped with hunger by eating grass, tree bark and roots. Tuberculosis has made a comeback in North Korea due to malnutrition, and 47 percent of children under 5 are stunted as a result of food insecurity.

The report is based on interviews with over 40 North Koreans now living abroad, most of whom left the North between 2004 and 2009, and with health professionals who work with North Koreans.

"International law, including covenants ratified by North Korea, demands that the government provide adequate levels of food and health care to its population, and to seek international cooperation and assistance when it cannot," said Catherine Baber.

North Korea was hit by famine in the early 1990s, resulting in the deaths of about a million people, followed by food shortages, which are still ongoing.

In 1995 the government finally made an appeal to the international community for food aid and assistance.

But even after the UN and humanitarian aid agencies began distributing food and other essentials in the country, the government impeded their work on the ground, preventing them from accessing large segments of the population.

With the collapse of the government-run food rations and mass job losses due to closures of factories and other state-run enterprises in the 1990s, many North Koreans suffered immense hardship and struggled to survive.

Between 1995 and 2005, the WFP’s emergency operations in North Korea supported up to one-third of the population. Adhering to its “no access, no food” policy, it improved its monitoring of food distribution in North Korea due to greater access within the country.

In September 2005, North Korean authorities announced that it had enough food and ordered the WFP to end its humanitarian aid programme citing better harvests.  The North Korean government stated that only medium- and long-term (technical) development assistance would be permitted. However, international food aid through the WFP, which ended in December 2005, resumed a year later after devastating floods in 2006 and 2007.

» Read our report: The Crumbling State of Health Care in North Korea (pdf 690kb)

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Starving North Koreans forced to survived on diet of grass and tree bark (Feature, 15 July 2010)