In recent months, small amounts of information about the state of the North Korea's health system have made their way out of the country. And the data points have gone from bad to worse to revisiting accusations of massive human rights violations. While there is no more vital diplomatic effort in the world today than the denuclearization of North Korea, there is a second deadly force at play for the country’s more than 25 million citizens: health. And that means health security concerns for the rest of the world.
North Korea, officially the Democratic People's Republic of Korea, has undoubtedly faced many natural and man-made disasters in recent decades, but the greatest of which appear to stem from the economic collapse in the 1990s and subsequent deterioration of the citizens in the country. Since that time there has been a sharp decline in life expectancy – 12 years less than their genetic peers in South Korea. The North Koreans are also estimated to be 1-3 inches shorter than South Koreans, primarily due to chronic malnutrition and extreme poverty. At The Center for Strategic & International Studies (CSIS), experts contend that health decline is a direct result of choices and priorities made distinctly by the Kim family to create politically defined castes and introduce famine to the masses so that military efforts could be funded.
So, despite claims from North Korean media that the country developed a cure-all drug that had eradicated HIV/Aids, Cancer and Ebola from the entire country, the truth is that there are millions of lives hanging in the balance, needing access to basic necessities like clean water, food and vaccinations. And without those, an estimated 60,000 children will starve, millions of adults will live with communicable diseases other regions of the world have eradicated, and the world will continue to fight weapons that are only a part of the larger problem.
But why is global health so important for national security?
To understand a culture and a people, you must understand more than the military – which is what most of the world seeks to understand about North Korea. Nuclear and biological weapons are of global security priority. But the focus cannot be limited to those weapons alone. It must also be on the status of the citizens, culture, economy, and most importantly, what happens during and after the Kim dynasty? What happens to North Koreans now, could have global implications when they leave their country’s boarders in the near future.
There is a joke in China that the North Korean’s have two weapons of mass destruction, nukes and tuberculosis (TB). And not just TB, but multidrug resistant TB, which knows no boundaries or borders, and is spread person to person through the air. The country is also experiencing exceptionally high rates of malaria and hepatitis B. While many health-related organizations have been able to skirt restrictions about entering the country for the purposes of health care, all signs point to a growing number of destructive diseases and shrinking number of professionals that can help. Which in turn means a growing body of diseases and human destruction just waiting to spill over the North Korean borders.
In fact, multiple sources have confirmed over the years that the political regime had strategically used food and starvation as tactics to control the people and get the United Nations and other visiting personnel to see whatever the North Korean elite wanted them to see. However, an early 2018 defector gave the world some insights into the status of the people, including the military, as it stands today. The soldier in question was cared for after crossing into South Korea with multiple bullet wounds. But what doctors found inside the man shocked even the most experienced doctors: dozens of parasites in his intestines and roundworms up to a foot long. It is believed that because North Korea does not have chemical fertilizer, farmers use human excrement – infamous for spreading parasites like the ones in the defectors stomach.
Can diplomacy make a difference?
Though humanitarian exemptions are written into all sanctions against North Korea, recent years have seen mass exodus (ie: voluntary departures and expulsion) of nonprofit, nongovernmental and aid organizations because basic principles of humanitarian action were forbidden. Even banking transfer systems have collapsed. And it’s been consistently reported by organizations like Medecins Sans Frontieres/Doctors Without Borders that for decades medical supplies and food aid were not delivered to those who needed it. As recently as last month (April 2018) commodities funneled through China have been met with resistance, and the Global Fund reached a breaking point, declaring that it will be pulling out of the country within weeks.
When more than 40% of citizens (10.5 million people) are considered undernourished, and millions more have little food, humanitarian aid could go a long way in fighting the health decay of North Koreans. Further, it could foster a cultural revolution – and build trust - within the common people, as well as lead to health, education and job opportunities to help increase the average yearly income is North Korea – currently just over $1,000 a year. But as it stands, neither South Korea or China are really prepared for the health insecurity, ramifications of North Koreans crossing their borders. That said, so long as North Korea focuses
However, as President Trump and Kim Jong-Un prepare for a potential meeting to discuss nuclear disarmament, the implications for global health hang in the balance. Without a meeting, and without compromise, the situation is North Korea will likely grow worse. UN and humanitarian efforts will continue to be scaled back (meaning even less food, clean water and medical aid), and multidrug resistant TB and malaria stand to spread rapidly across the nation. Conversely, if diplomacy prevails – or talks are even allowed to advance – sanctions against North Korea could be decreased, and a flood of humanitarian aid and health care could enter the country.
Although North Korea’s health decay appears to be truly horrific and dangerous to the outside world, the truth is that for most of the country, health data is not available. Hopes are that in the coming months, real change is possible, and the world gets a better understanding of life, death and disease in North Korea.