United Nations System
Standing Committee on Nutrition



 

Nutrition Information in Crisis Situations - Democratic Peoples Republic of Korea
 


NICS 9, May 2006

The Democratic People's Republic of Korea (DPRK), with an estimated 23 million inhabitants in a territory of 120,540 km2, shares borders with South Korea, China and Russia (see map). DPRK has a centralised socialist economic system. Often referred to as a uniquely closed political system, the state exerts pervasive control over the population, the economy, and information (Becker, 1998; UNCHR, 2004; Eberstadt, 10/04). Following floods in 1995, DPRK requested humanitarian aid for the first time in its history and foreigners were allowed into the country (Becker, 1998). Ten years later, the government of DPRK declared the emergency over (AFP, 16/03/05; Concern, 20/09/05; Reuters, 10/10/05) and asked the UN agencies and NGOs working in the country to terminate their emergency programmes by the end of 2005 (Concern, 20/09/05; DPA, 22/09/05). The aim of this article is to review the trends in the nutrition situation and underlying factors such as food security over this decade and try to ascertain if the emergency is over, recognising that in the "Hermit Kingdom", the paucity of reliable information creates many challenges (Becker, 1998; ICG, 25/04/05; Noland, 07/03).

Background

Prior to being divided into two at the end of the Second World War, the northern part of the Korean peninsula was mostly industrialised, and the south was the bread basket which produced most of the food (USCHRNK, 2005). After the war, North Korea pursued a policy of food self-sufficiency (USCHRNK, 2005), but with only about 20% of arable land, and an adverse climate, significant yields could only be achieved by intensive farming, highly dependent on external inputs such as fertilisers and pesticides. Intensive farming together with increased deforestation eventually resulted in soil depletion and erosion. Areas under cultivation have been mostly concentrated in the south of DPRK, with South and North Phyongan and South and North Hwangae representing 60% of the cultivated areas (FAO/WFP, 25/11/1997).

It seems that North Korea did well in terms of economic development after the Korean war up to the 1970s, with remarkable economic growth, and rapidly improving living standards (ICG, 25/04/05). The harvest doubled from 3.5 m MT in 1966, to 7.7 m MT in 1984, as a result of expansion of land under cultivation, mechanisation, irrigation, and heavy use of fertilisers (ICG, 25/04/05; Woo-Cumings, 2002). Requisite inputs for agriculture, and shortfalls in cereal production, were mostly covered through the preferential system of trade with the USSR, which also provided most of North Korea's needs for coal and refined oil, and one third of its steel (Noland, 07/03).

North Korea's economy, farming, and people's entitlement to food, goods, and basic needs were centrally controlled by the state. Cereals were to be dispatched to the population by the Public Distribution System (PDS) at subsidised prices, after the collective farms had kept their part. This ensured the redistribution of cereals from surplus to deficit areas (Woo-Cumings, 2002). Entitlements seemed to be a function of worker categories and political status. North Korean society is apparently organised based on a classification of people within three broad strata, and 51 categories, which depends on their perceived loyalty to the party (FIDH, 11/03). The lower perceived "hostile" class is thought to represent about 27% of the population, while the "basic mass" (middle class) could represent 45%, and the "core mass" or upper class (staff of the party, government and army) 28%. This classification, although denied by the government of DPRK, seems to be confirmed by North Korean refugees and to serve as a basis for entitlement to basic needs such as food, housing, health care, and education. Occupation seems also to be allocated according to these categories, with the perceived less reliable people being employed in dangerous work and hard labour, and the upper class being recruited as staff for the party, government, and army. Families from the lower class seem mostly located in the inland regions (Seong-Ho, 03/03).

Onset of the crisis

The economic crisis and the related food shortages are thought to have begun in the late 1980s (Becker, 1998; Eberstadt, 10/04) and intensified with the collapse of the former USSR in the early 1990s that ended aid and subsidised trade with North Korea (Eberstadt, 10/04). At the same time, China, the other major trade partner, began demanding hard currency settlement for oil imports (ICG, 25/04/05). By 1993, imports from Russia were only 10% of their 1987-90 average (Noland, 07/03). Energy supply dropped from 24 m MT in 1990 to 14 m MT in 1998 (ICG, 25/04/05), which paralysed the industry, transport, and agricultural sectors. Moreover, the policy of the North Korean government which contracted debts in the 1970s towards Western countries, the former USSR, and China, without repaying them, discouraged these countries from providing further loans (Becker, 1998) and North Korea failed to establish new trade relationships. This economic crisis was compounded by heavy floods in 1995 and 1996 which damaged crops and the infrastructure for production of power (Woo-Cumings, 2002). Drought and tidal waves in 1997 further worsened the situation (Katona-Apte, 1998). While it is difficult to determine exactly when the crisis began, it seems likely that it was well before 1995 when humanitarian aid was first requested.

Impact of the crisis

The impact of these combined problems of debt, lack of external raw materials and energy imports together with natural disasters of flooding in 1995 and 96 followed by drought the next year provoked an enormous crisis in 1995/7. It is thought that as many as 70% of factories, mines, schools, hospitals, and other institutions had stopped functioning by 1997 (Becker, 1998).

Sharp decline in agricultural production

According to various estimates, there was a decline in agricultural production in the 1990s compared to the 1980s (Noland, 07/03), and the government failed to take action to guarantee adequate food supplies (USCHRNK, 2005). The sharp decline of fertilizer production, as a result of economic collapse, has been thought to be the main contributor to reduced crop yield (Woo-Cumings, 2002). The use of fertiliser dropped from 650,000 nutrient tonnes in 1989 to 100,000 in 1996 (FAO/WFP, 22/11/04). In 1998, it was estimated that only 20% of the tractors were operational, due to fuel and spare part shortages (FAO/WFP, 25/06/98). Floods and drought seem to have resulted in the loss of about 1.5 m MT of grains in 1995 and 1.6 to 1.9 million in 1997 (Katona-Apte, 1998), and livestock also seems to have decreased markedly (FAO/WFP, 22/11/04).

Public heath

The ability of the government to supply medicine and maintain the medical infrastructure seems also to have collapsed with the economic crisis (UNICEF, 12/99). Testimonies seem to confirm the collapse of the health structures which, at best, provided a diagnosis but no medication (GF, 03/04). Incidence of diarrhoea and acute respiratory infection seemed to have risen as well as cases of tuberculosis (UNICEF, 12/99). The quantity and the quality of water seemed to have decreased (UNICEF, 12/99).

Public food Distribution System

The rations provided through the PDS seem to have been cut as early as the late 1980s, and again in the early 1990s, when a campaign on "let's eat two meals a day" was launched (AT, 15/01/05; USCHRNK, 2005). The PDS seems to have virtually collapsed between 1994 and 1996, with the vestiges of its functionality depending on the regions and population categories (AT, 15/01/05; GF, 03/04; Seong- Ho, 03/2003; USCHRNK, 2005). The north-eastern areas (North and South Hamgyong, Yanggang and Kangwon provinces) are thought to have been affected two years earlier than other provinces (Noland, 07/03; Woo-Cumings, 2002), maybe partly because of the collapse of the transportation system (USCHRNK, 2005). Those areas were traditionally the poorest, and were food-deficit areas due to inhospitable growing conditions and high urbanisation (USCHRNK, 2005). According to a study, derived from testimonies of refugees mostly coming from North and South Hamgyong, government rations (including PDS, farmers and military rations) provided on average about 260 g/pers/day in 1994, and represented the main source of food for 60% of the families (Robinson, 1999). The rations however constantly declined afterwards and were only 42 g/pers/day in 1996 and 24 g/pers/day in 1997. They only represented the main source of food for 28.4%, 9.8%, and 5.7% of the families in 1995, 1996 and 1997, respectively. In 1996, the provision of food seems to have been decentralised to the county level, and distributions probably varied a lot depending on the county (Natsios, 08/99). The PDS is thought to have remained functional, mostly in the major cities, for high-ranking party members, officers, and soldiers (Becker, 1998; Noland, 07/03; Seong-Ho, 03/03), although the rations were cut by half (AT, 15/01/05). The military seemed also to have suffered from lack of food, and to have engaged in violence against civilians to get food (Becker, 1998; GF, 03/04). People categorised in the "hostile" strata seemed the most affected, and when the food distribution was limited, no food at all was provided to them (GF, 03/04).

Coping mechanisms

The population developed a number of coping mechanisms, which, at the peak of the crisis, were however often insufficient to prevent starvation and deaths.

According to Robinson's study among refugees, as the PDS ration decreased, people's main sources of food became purchase - for about 25% of the families in 1995,1996, and 1997 (it was 16% in 1994); barter - for about 15% of the families (vs. 4% in 1994); and self-grown for about 7% (Robinson, 1999). Foraging for wild greens, bark of trees, and roots increased the most significantly, from 11.9% in 1994 to 22.8%, 34.7%, and 40.2% in 1995, 1996, and 1997, respectively. According to these figures it seems that purchase, barter, and self-grown were stretched to their limits, as they didn't increase while government rations decreased, and then people seemed to have been more and more reliant on foraging. The consumption of unusual wild foods is thought to have led to a high number of deaths (Becker, 1998; GF, 03/04). The same pattern is observed from other testimonies stating that from 1995, as the PDS ration decreased, people began to sell their assets for food, but that by mid-1996, as no assets remained, it was harder and harder to get food (Seong-Ho, 03/03). People also seemed to rely on exchanging whatever could be stripped from places of employment for food diverted from cooperative or hidden plots (USCHRNK, 2005). Secret pre-harvesting seemed also to have been widespread (Natsios, 08/99), and unauthorised markets seemed to have proliferated in both towns and the countryside during the famine (Becker, 1998).

Most of the coping mechanisms which were developed for survival were not authorised by the government, which seemed to have reinforced punishments for trade and stealing of food (Becker, 1998). The lower stratum of the society seemed more at risk when caught, and more vulnerable to thieves (GF, 03/04). At the end of 1998, control of the population and population movement was reinforced (Natsios, 08/99).

The famine

At the peak of the crisis, probably somewhere between mid-1995 and mid-1997 (GF, 03/04; Natsios, 08/99), a famine certainly occurred, although it has not been witnessed by foreigners (who were prevented from accessing a number of areas) and its extent is difficult to determine (Becker, 1998).

Mortality rates seemed to have increased between 1996 and 1997, whilst the birth rate significantly declined within the same period (GF, 03/04). The same pattern is reported in another study conducted through interviews with refugees, who mostly came from the north-eastern province of North and South Hamgyong (Robinson, 1999). The birth rate was halved between 1996 and 1997, and crude death rate increased from 28.9/1,000 in 1995, to 45.6/1,000 and 56.0/1,000 in 1996 and 1997, respectively, that was far higher than the 5.5/1,000 derived from the 1993 census. According to the government, there were 220,000 deaths from starvation and related diseases between 1995 and 1998 (FIDH, 11/03; USCHRNK, 2005). Several studies attempted to quantify the number of deaths, relying on testimonies from refugees or extrapolation from demographic data; and estimates ranged between 600,000 and 3.5 m deaths, with one million, or about 5% of the total population, being regarded as a reasonable estimate (GF, 03/04; Goodkind, 2001). Mortality of children less than nine years old, and of the elderly more than 60 years old, seemed especially high (GF, 03/04). Widespread hunger oedema, and a typhus epidemic, were also reported (Becker, 1998).

It is not clear if the famine hit mostly urban or rural areas. It might have depended on the regions. Although there are some reports that people in rural areas had better coping mechanisms, as some were able to cultivate small plots (USCHRNK, 2005), testimonies from the northern area revealed that peasants were not better-off because of bad harvests and the required quota still being collected by the government (MSF, 02/05/02). It also seems that cities offered more coping mechanisms through widespread black markets. By the mid 1990s, conditions seemed to be very different according to geographical regions and social groups (Noland, 07/03). Pyongyang seemed to have been relatively protected, but still also to have experienced shortages (USCHRNK, 2005).

Humanitarian assistance

DPRK requested humanitarian aid in 1995, leading to a widespread response from countries, UN agencies, and NGOs. Food aid was about 500,000 MT in 1995 and 1996, rising to about 1 m MT, or about 15% to 20% of total minimum food needs, between 1997 and 2000 (INTERFAIS). WFP has mostly targeted aid to children, the elderly, and pregnant and nursing women, and has distributed fortified foods (WFP, 23/07/04). There has also been humanitarian aid in other sectors such as support to health infra-structure, agriculture, and water and sanitation.

The provision of humanitarian assistance has been highly controversial as the reclusive policies of the government render the monitoring of humanitarian aid very difficult (USCHRNK, 2005). Food was only authorised for channelling through the government distribution system. Only a few expatriates (who must not be able to speak Korean) were allowed into DPRK, and their movements were restricted. Monitoring visits had to be requested in advance and were sometimes refused. Expatriates were allocated official counterparts who accompanied them during their field visits but often had no specific technical or sectoral skills (USCHRNK, 2005). Except in Pyongyang, the capital, expatriates were generally not allowed to move freely out of their official compound. However, it seems that WFP expatriates were authorised to do so in the recent years (USCHRNK, 2005). Forty to 50 counties, representing about 16% of the population, have always remained out bounds for humanitarian workers (FAO/WFP, 22/11/2004).

Some NGOs pulled out of the country after a few years of operation, because of the difficulties in monitoring aid, arguing that humanitarian assistance was not reaching the most needy (MSF, 02/05/02). Other humanitarian agencies have continued their programmes. It has been argued that some of the humanitarian aid was diverted to the military (USCHRNK, 2005), or was sold on the markets (Natsios, 08/99). It has also been stated that, at least in the mid-nineties, the government concentrated external aid to some areas, and denied it to the northern provinces of North and South Hamyong and Ryangang, representing 5.4 million people (Becker, 1998; USCHRNK, 2005). It has also been claimed that when food aid began to arrive the government cut commercial imports of food, and relocated the funds to other priorities, such as military, even during the famine (USCHRNK, 2005).

Post crisis recovery

The situation appeared to have somewhat improved since 1999 (Eberstadt, 10/04). Although, some degree of recovery has been reported, it does not seem that agriculture and industry have markedly recovered (ICG, 25/04/05). The energy crisis also seems to have persisted (ICG, 25/04/05). The reported level of imports dropped sharply between 1990 and 1998 after which it increased again and by 2003 was twice the value of 1998. Exports were also known to have shown a sharp drop since 1990 and have only recovered somewhat since 1998, although to a much lower extent than imports. The trade deficit has therefore increased, and this is thought to have been financed by contributions from governments such as the US, China, South Korea, and Europe, in a mood of "engagement policy", and by illicit trade (Eberstadt, 10/04). Between 1999 and 2003, it is estimated that annual GDP growth was about 1 to 2% (ICG, 25/04/05), while it was -6.3 in 1997, and -1.1 in 1998 (FAO/WFP, 22/11/04).

Agriculture production

In 2003 and 2004, the amount of fertiliser used had doubled compared to 1996, mainly due to donations, and was slightly more than 200,000 nutrient tonnes, although still far lower than the 600,000 thought to be used in 1989 (FAO/WFP, 22/11/04). 55% of the tractors seem to have been operational since 2001, compared to 20% in 1998 (FAO/WFP, 26/10/01; FAO/WFP, 22/11/04), and the supply of power had also improved in farms (FAO/WFP, 22/11/04). Although agricultural production has stabilised since the mid-nineties, it has never returned to the quantities produced in the 1980, and is thought to have been below 4 m MT until 2002 (Noland, 07/03). In 2003/2004, the estimate of cereal-equivalent production was about 4.3 m MT (FAO/WFP, 22/11/04), and was again 4% higher in 2005 than in 2004 (USDA, 18/11/05). Livestock also seems to have recovered somewhat, with an increase especially in the number of goats and rabbits (by 260% and 540%, between 1996 and 2001, respectively) which the government had encouraged the rearing of as well as poultry (FAO/WFP, 26/10/01).

Economic reforms in 2002

Economic reforms, such as the increase in official prices and wages, and market reforms were announced in July 2002 (ICG, 25/04/05). Food, fuel, and electricity prices increased by 26 times on average, and rice increased by 550 times (ICG, 25/04/05); while wages only rose by an average factor of 18, but with discrepancies depending on the work categories (ICG, 25/04/05). Agriculture and industry were more decentralised, and markets were authorised (ICG, 25/04/05). It seems that well-supplied markets have flourished and that informal local markets have also increased (FAO/WFP, 22/11/04). There was also widespread development of cooperative activities, such as sale of handicrafts, snacks, or shoe or bicycle repair (FAO/WFP, 22/11/04).

Persistence of food insecurity

While some Koreans have prospered, the situation seems poor for most due, among other things, to hyperinflation. With the breakdown of the PDS and the development of a market economy, food insecurity had become more related to the capacity of the families to command resources (USCHRNK, 2005). People who could benefit from foreign exchange seemed more able to cope with the present system (USCHRNK, 2005). The physical proximity of surplus areas was also a factor affecting food security (Noland, 07/2003). According to WFP/FAO, at least 30% of the working age force was under-employed or unemployed, and wages were reduced to below subsistence levels in 2004 (FAO/WFP, 22/11/04). The unemployment rate was double for women compared to men. Moreover, even people with a stable job seemed to engage in commercial transaction to increase their income (Seong-Ho, 03/03). Coping strategies, such as receiving food from relatives in rural areas, gathering wild food (80% of families in urban, and 65% in rural areas), using alternative foods such as acorn flour, or sea and riverweed, cultivating small gardens, and bartering personal belongings were widespread (FAO/WFP, 22/11/04; USCHRNK, 2005). According to WFP/FAO, the most vulnerable were people dependent on the PDS with only one income and several dependents (FAO/WFP, 22/11/04).

Reinstallation of the Public food Distribution System in late 2005

It is unclear to what extend the PDS has remained operational for the majority of the population. The PDS seemed to have been only a marginal source of food for years, at least in the north, according to recent testimonies from refugees in China. The complete abolition of the system was denied by the North Korean government when it was raised by South Korean media in 2004, but it is thought that the PDS only continued to operate regularly in major urban centres (AT, 15/01/05). It seems that the PDS rations varied between 200 and 300 g/pers/day between 1998 and 2004, depending on the year, with important variations between counties and months (USCHRNK, 2005). In November 1998, the three best counties received an average of 350 g/pers/day, while the three worst counties only received an average of 125g/pers/day (WFP/FAO, 29/06/1999). Rations received by farmers at the collective farms seemed higher than rations distributed through the PDS (USCHRNK, 2005). The government of DPRK announced in October 2005 that the PDS will be reinstalled at a ration of 500 g/pers/day and that trade in grains was banned, which also suggests that prior to this the PDS was probably not fully functional (HRW, 05/06). There have since been reports that the ration distributed was smaller than 500 g/pers/day. Although grain trade has been banned, it seems that black markets have continued to operate, and that prices have markedly increased.

End of emergency food aid

Food aid has been significant since the beginning of this overall crisis with a peak at 1.5 m MT in 2001, and a decline afterwards to 0.68 m MT in 2004 (INTERFAIS) reflecting a tendency to fatigue by some donors due to diplomatic conflicts such as the nuclear programme developed by DPRK (USCHRNK, 2005).

In mid-2005, North Korea asked the UN agencies and the international NGOs working in the country to terminate humanitarian aid by the end of 2005 (Concern, 20/09/05; DPA, 22/09/05). North Korea also decided not to be part of the humanitarian Consolidated Appeal Process in 2005 (AFP, 16/03/05). The government stated that the emergency was over, and that the country currently needs long-term projects and development assistance, only occasionally monitored by expatriates (Concern, 20/09/05, Reuters, 10/10/05). It has been suggested that North Korea would get privileged aid from donors, such as South Korea and China, which might exert less monitoring (Chosun Iibo, 08/09/05). In 2006, North Korea has asked South Korea for 500,000 MT of food and 450,000 MT of fertiliser (Gov of RK, 27/04/06; Reuters, 02/05/06). WFP will continue its programme on a smaller scale with 150,000 MT of food to support 1.9 m people, compared to about 500,000 MT of food to support 6 m people previously (Reuters, 11/05/06; WFP, 11/05/06). WFP will only work in 30 counties, and its presence in the field will be reduced.

Nutrition situation

Before 1998, there were no comprehensive national nutrition surveys conducted in the country, but observations in orphanages, nurseries, and kindergartens seemed to indicate a worsening of the situation by mid-97 (see RNIS supplement on North Korea; Katona-Apte, 1998). From 1998 onwards, national nutrition surveys have been conducted every other year (CBS, 10/00; CBS, 11/02; CBS, 02/05; EU/UNICEF/WFP, 98), with a presence of expatriates in the field in the 1998, 2002, and 2004 surveys. However, a number of limitations render interpretation of the results and analysis of the trends of the surveys difficult. Firstly, access to the whole country was not available during the surveys (table 7). The 1998 and 2002 surveys were estimated to have covered about 71% and 75% of the total population, respectively. Coverage estimates were not available for the other surveys. Secondly the methodology of selection of clusters, families, and children, and the age range covered by the surveys, varied (table 7). In addition, in the 2002 and 2004 surveys, only the youngest child of the family was measured, although, when adjusted for the missing older children, the prevalence of acute malnutrition didn't change significantly.

Table 7 Methodologies used in the surveys conducted in DPR Korea, 1998-2004 (CBS, 10/00; CBS, 11/02; CBS, 02/05; EU/UNICEF/WFP, 98)

Although the surveys are not directly comparable due to the reasons cited above, trends seem to indicate a gradual improvement of the nutrition situation, with a diminution of acute malnutrition and stunting (table 8). Stunting in children is mostly determined by ante-natal and early childhood conditions in the first two years of life. The rate of stunting might then be taken to reflect the conditions at the time of birth and early childhood of these children. If rates of stunting recorded in the four surveys are plotted against the year of birth (figure 14), it would seem to indicate that conditions were already very poor at the beginning of the nineties and have improved since 97-98. The peak of the famine is not reflected in this figure, which might be due to a combination of different factors, such as the low birth rate during this period, especially in the more affected families. In any case, the above analysis should be regarded with caution due to the many uncertainties although the decrease in stunting rates from over 60% to less than 40% in 6 years is quite remarkable.

Figure 14 Stunting in children aged over two years by year of birth and survey

The results of the last survey, conducted in 2004, showed a situation which, although greatly improved, was still precarious with an average wasting rate, and a significant level of stunting (table 8). The wasting rate was comparable with Afghanistan and Vietnam, while the stunting rate was again comparable to Vietnam but lower than Afghanistan (Childinfo).

Table 8 Malnutrition in DPR Korea, 1998-2004 (CBS, 10/00; CBS, 11/02; CBS, 02/05; EU/UNICEF/WFP, 98)

Moreover, there were wide discrepancies between provinces (table 9). The lowest rates of wasting were found in Nampo and Pyongyang cities, while the highest rates, three-fold higher than in Pyongyang, were reported in Ryangang, North and South Hamyong and South Hwanghae. Stunting followed the same pattern. This is in line with the analysis of food security in the country (see above), and the food consumption of the mothers, who reported the lowest frequency of consumption of pulses/meat/fish/eggs in South Hamgyoung and Ryangang provinces.

Table 9 Malnutrition in DPR Korea by province, 2004 (CBS, 02/05)

Nutritional status of mothers of children aged less than two years, measured by MUAC, showed that about 32% of the women were thin (MUAC < 22.5 cm) in 2002 and 2004. Moreover, of the 25% and 50% of the women who authorised haemoglobin measurement in 2002 and 2004, respectively, about a third were anaemic (Haemoglobin < 12 g/L).

Child feeding practices although less than adequate with only 65% to 70% of the less than six-month olds exclusively breastfed, are still high compared to some other countries. About 90% of the children were still breastfeeding at one year but the percentage of breastfed children decreased rapidly after one year of age.

Overall

It is difficult to analyse the food and nutrition situations in North Korea due to the paucity and uncertainty of the reliability of information. It seems however that the nutrition situation of the children surveyed in 2002 and 2004 compares with the regional average. Although the economic and agricultural situation seems to have improved in recent years, it is still precarious. The food security and nutrition situations in the country are still very fragile and need continuous attention. Furthermore it is probable that the lower class, thought to represent about one third of the population, is still likely to be suffering the consequences of food insecurity more than the rest of the population.


RNIS 22, December 1997

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