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"Lost Generation: The Health and Human Rights of North Korean Children, 1990-2018," produced by Dr. W. Courtland Robinson and a team from the Center for Humanitarian Health at the Johns Hopkins Bloomberg School of Public Health, paints a troubling picture of the status of North Korean children in the aftermath of the country's famine in the mid-1990s.
Although conditions have improved since the peak famine years of 1995-98, "the health and human rights conditions of children remain dire," the report concludes. "The mortality and other demographic impacts" of the famine "were severe in the 1990s but have also persisted into the 2000s and the 2010s," with the impact "most acute among children."
Healthcare systems have not been fully restored from their collapse two decades ago. "While modernization in secondary and tertiary hospitals has been a priority under Kim Jong-un as well as new telemedicine initiatives and the construction of a large new medical center in Pyongyang, there is continued evidence of under-resourcing of the health sector." This has resulted in the re-emergence of illnesses such as TB and malaria.
Malnutrition contributes to these health problems. There are "clear indications of a continuing problem," in which "undernourishment is a common denominator for many of the health problems afflicting North Koreans," the study states. Children can no longer rely on a government food rationing system but need to depend on informal markets.
School systems, particularly in rural areas, have also deteriorated, with children forced to perform labor duties outside the classroom. Many children, such as "kotjebi," the homeless street kids, or those in orphanages, suffer more hardships than their peers.
The blame for these conditions firmly rests on the policies of the North Korean government. "The North Korean state's gross failure to protect the basic health, welfare and well-being of the population ― including children ― constitutes more than a violation of elementary normative principles but a violation of core international human rights treaty obligations," the study notes.
Even during the height of the famine, Pyongyang reduced the purchase of imported food while it diverted funds to the build-up of its military, including the development of nuclear weapons and missiles.
This produces a dilemma for humanitarian aid organizations, such as U.N. agencies. Resources are needed to address the humanitarian needs of North Koreans. But these efforts cannot be separated from human rights concerns.
The report recommends a multifaceted approach to deal with this issue. For one, North Korea needs to share accurate statistical data to identify the most urgent humanitarian needs and make sure that aid is delivered in a transparent matter.
Increased cooperation between the Pyongyang government and aid agencies would prepare the groundwork for extending help beyond the current delivery of humanitarian supplies of food and medicine to long-term development assistance projects. More importantly, North Korea needs to devote more resources to improving its agricultural, healthcare and education sectors.
These measures should be accompanied by giving U.N. and Red Cross representatives access to monitoring the human rights situation in North Korea. South Korea should also restore adequate funding for the monitoring of North Korean human rights.
But the report suggested that the international community needs to do more in addressing the humanitarian crisis in North Korea, which would help establish a climate of trust.
It stresses that the U.S. and other nations should respond to the U.N.'s call for contributions to meet the food, health and sanitation needs of 6 million of the most vulnerable North Koreans. This year, the U.N. is seeking nearly $120 million. But as in previous years, only about a fifth of this amount will be pledged, with the biggest donors expected to be Switzerland, Sweden, Canada, France and Russia.
The report also suggests the U.S. ease regulations governing humanitarian aid to North Korea, including restrictions placed on travel by American aid workers, who must now go through a cumbersome approval process. This threatens to prevent the timely delivery of humanitarian aid to North Koreans.
The U.S. Special Representative for North Korea Stephen Biegun has said he will seek to improve the delivery of appropriate assistance.
When I recently asked Biegun's predecessor, Joseph Yun, about the possibility of relaxing these restrictions, he said this would be a top priority in Washington. But he then added that nothing would likely be done until at least a limited deal on North Korea's denuclearization is achieved. The impasse on U.S. humanitarian aid to North Korea is likely to continue.
John Burton (johnburtonft@yahoo.com), a former Korea correspondent for the Financial Times, is a Washington, D.C.-based journalist and consultant.