Doctors or no doctors in North Korea? Healthcare in the hermit state.
I’ve never been to North Korea and I’ve no idea what the health care system is like. I am aware of the stories from a decade or so ago of terrible malnutrition and starvation that claimed 1m lives and I can Google to discover that life expectancy is currently around 67 years – much the same as in Burma or Pakistan. Given the unceasingly bad things we hear about North Korea, the nuclear-armed “rogue state” and its dictator, Kim Jong-il, I was not especially surprised by last week’s Amnesty International report which revealed the crumbling state of the country’s health care system.
Amputation and other major surgeries carried out without anesthesia were just one indication of the dire state of North Korea’s healthcare system, said the report, adding: “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. This is especially worrying as North Korea fights a tuberculosis (TB) epidemic. A growing number of patients have developed a resistance to first-line anti-TB drugs. This is especially worrying as North Korea fights a tuberculosis (TB) epidemic. 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. It is crucial that aid to North Korea is not used as a political football by donor countries.”
But just a day after the report was published, others began to question its contents. The World Health Organisation (WHO) said the report was based on old information, passed on by people who had fled from the country – as Amnesty openly admitted – and had not taken into accounts various improvements. “All the facts are from people who aren’t in the country,” WHO spokesman Paul Garwood told reporters in Geneva. “There’s no science in the research.”
He added: “I’m not saying they’re not credible accounts. But it’s not taking into account some of the things that are happening today.”
The apparent dispute between the two reputable organisations followed a visit to North Korea by the WHO’s director general Margaret Chan who returned to praise the country’s healthcare system in surprisingly effusive terms, describing it as the “envy of the developing world”. She said there was no shortage of doctors though the country still faced considerable healthcare issues, including malnutrition. Not surprisingly, Ms Chan’s words were leapt upon by plenty who believed she had been deceived and hood-winked by the North Korean officials who escorted her on the visit. Some suggested that making such comments was the price the WHO was forced to pay for continued access for its officials and workers to North Korea.
One of the problems, of course, is that North Korea is not an open country where independent organisations can easily monitor such things as the healthcare system. It’s very difficult for journalists to enter and do anything other than the most cursory job of inspection or investigation.
Perhaps as a result of this, I am intrigued to know more. I have absolutely no bag to carry for North Korea or its leader, who rules over the people in a wretched, totalitarian style. At the same time, if improvements in such key areas such as healthcare truly have been made, then it is something that ought to be reported as well. One emailer who contacted me about this story said they had no desire to defend the “Dear Leader” but thought it was important to question the “reflexive demonisation” that currently exists towards so many of the West’s “official” enemies – Iran, Venezuela, Cuba.
So where does the truth lie about North Korea and its healthcare system? I’ve contacted Amnesty to see if it stands by the report. I will update this when it responds.
I am very grateful to Sam Zarifi, of Amnesty International, who has taken the trouble to respond in both a detailed and very timely manner. His input is appreciated.
Mr Zarifi said:
Amnesty International stands by its report on the dire state of the health care system in North Korea. We were very clear in the report about the methodological restrictions we face in our work on North Korea, as we have no access to the country. We based our information in part on interviews with North Koreans who had fled the country, and we sought people with the most recent information. But we verified this information through interviews with health care providers and aid workers with strong information from inside the country. Not surprisingly, these people requested anonymity lest they lose their access.
The WHO itself was quite explicit that they were not criticizing our report, and that what we said was complementary to their views on North Korea — we take them at their word. Certainly, Amnesty International does not have sufficient access to carry out a comprehensive, ’scientific’ study of the country’s health care system. We are not aware whether the WHO can monitor the country freely enough to conduct a proper, comprehensive, scientific survey of the country’s health care system either. If they can, we would very much like to see that information made public.
The bottom line is that we believe that the North Korean government has put in place policies that have seriously aggravated the impact of the country’s food crisis on the population’s health. The North Korean government has systematically under financed its health care system, whilst claiming that it provides free universal health care. As reported by the WHO in the most recently available data, North Korea spends less than US$1 annually per capita on health care. Again, based on the WHO’s information, this put North Korea at the very bottom of the list of all countries, world-wide. Our view is that the North Korean has to do quite a bit more to meet its obligations, notwithstanding the hard work done by the WHO and other aid agencies in the country.
This not just Amnesty’s position — it’s the position of the UN’s Special Rapporteur on North Korea, in whose most recent report (Feb. 2010) stated in paragraph 24:
<<24. There has been a general decline of the health and education infrastructure. Hospitals are short of medicines, schools are short of textbooks and both are short of
I have to point out that our report does indeed refer to some recent positive developments in the country, and to the WHO’s work explicitly, by referring to Dr. Chan’s own statements in this regard. On page 19 of our report, we state:
<<Following her trip to North Korea in April 2010,Margaret Chan, Director-General of the WHO, acknowledged achievements made in health care, such as 90 per cent childhood immunization coverage and success in controlling a resurgence of malaria, but said the state could do more:
“The health system requires further strengthening to sustain universal coverage and to improve the quality of services. More investments are required to upgrade infrastructure and equipment, to ensure adequate supplies of medicines and other commodities, and to address the correct skill mix of the health workforce.”>>
The WHO’s spokesperson also suggested that Amnesty’s information regarding the cost of health care for individual North Koreans was somehow inaccurate or out of date, claiming that no other source had reported that a system that is supposed to be free and universal health care is in fact neither. Amnesty stands by the information it presented and our conclusions in this regard. If the WHO has conducted comprehensive, scientific monitoring that invalidates our assertions we look forward to examining the data.
In criticizing the North Korean government’s poor performance in providing for the health of its population, we are not engaging in “reflexive demonization” but holding all governments accountable to international standards (the charge of ‘demonization’ seems particularly inapt, considering how much AI works around the world, and the number of countries whose conduct we monitor and, when necessary, criticize). North Korea has ratified the International Covenant on Economic, Social and Cultural Rights, under which it is obliged to progressively realize its population’s right to the highest attainable standard of physical and mental health and minimum essential food. Where a government is unable to provide the basic survival needs of its population (as is the case with North Korea), international law obliges it to seek cooperation and assistance from the international community. The North Korean government has instead politicized the issue of aid by refusing offers of aid and putting in place barriers to effective monitoring and distribution of aid to those most in need. Amnesty’s report was an effort to convince the North Korean government — as well as the international community — to focus on the well-being of the North Korean people above all else.
The WHO does very important work in North Korea (and around the world) and we support their efforts to help the people of North Korea. We hope our report helps persuade the North Korean government to improve its treatment of millions of people in the Democratic People’s Republic of Korea.
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