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Health System in North Korea Has Collapsed
Distribution of Goods and Staff Training Urgently Needed
Hong Kong, December 7, 1997 — "There are doctors and buildings, but no aspirin, no anesthetic, no basic medicines, no heating, no soap, no milk and therefore no patients. The health system in North Korea has collapsed leaving almost the entire population with no care except for traditional 'Korio' herbal medicine, and help is urgently needed" said Dr. Eric Goemaere, director of Doctors Without Borders/Médecins Sans Frontières (MSF)'sr Belgian office, who returned yesterday from an assessment mission in North Hamgyong, the northernmost province of DPRK (North Korea).
Dr. Goemaere warned: "The international community must not make the same mistakes as it did in Bosnia and Rwanda, where drugs were dumped and food and assistance were provided indiscriminately. Distribution must be monitored and training is essential."
In North Korea, there is one doctor per 300 inhabitants (compared with approximately one per 800 in most Western countries). But because there have been no supplies in the hospitals for the past three to four years, the doctors have not been able to help and patients have chosen to stay at home to die. Without patients or medicines, the medical staff urgently need training in patient care and drug management.
Although it is accepted that there is food scarcity (Government and WFP data on crops etc.), there are no visible signs of widespread "famine," such as skeletal people collapsing from starvation in the street. However there are signs that food is a problem and that coping mechanisms are weak: people are scavenging for the last grains of rice after the harvest has been taken in, and there are no markets nor fuel or transport for food.
Access around the country is improving, but full nutritional surveys to assess food distribution and levels of malnutrition have still not yet been possible at a village or household level. In the three southern provinces where MSF has been working for the past two and a half months--South Pyongan, North Hwanghae, and Kangwon--1,500 children under five years old have been treated for severe malnutrition in 38 feeding centers. Many were suffering from Kwashiokor or severe edema (malnutrition due to a lack of protein). Out of approximately 2 million people in the provinces, 1,500 is not considered a large number of malnourished children. What is significant is that the number of children admitted to the feeding centers doubled after the first month, as more and more people recognized that the hospitals and health centers could offer basic care once again.
There is clearly a crisis of confidence in the health system, but when the staff and supplies are in place, the patients return. If drugs are to be distributed and distribution monitored, it must be at a county hospital level and not just at a provincial capital hospital level (e.g., in North Hamgyong province there are 17 county hospitals outside the capital, each supporting 20 clinics for 2 to 3 villages each or 2-3,000 people).
Dr Goemaere added: "Direct donations will never cover the needs of 23 million people. The assistance needs to be diversified to meet the needs of the people." It is not just food and drugs that are needed but also seeds, tools, fertilizer and fuel, and even the basic materials for restarting the four drug producing factories which used to produce most of the medicines for the hospitals.
Dr Goemaere concluded: "In hospitals and village clinics, I was impressed by the doctors' motivation. Although access is improving steadily, aid agencies still have to obtain from the North Korean authorities greater access to those in need. On the other hand, those providing relief have to diversify the type of aid provided to increase North Korea's capacity to produce food and drugs. If these steps are not taken, the people of North Korea will become even more vulnerable to famine and disease over the next year."
MSF has been working in North Korea since 1995, when it provided emergency assistance after flooding by supporting existing health structures. In 1997, MSF distributed 2,200 tons of spring barley seeds to help the population cope with flood damage and increase agricultural production. Since July 1997, eight international staff members have been running a medical and nutritional emergency relief program in three southern provinces of North Korea.