by Ralph Hassig
We can only guess at the calculations that went into the decision to expel NGOs from North Korea. A decision of this magnitude could only be made by Kim Jong-il, and it is quite possible that his agriculture officials mislead him about the food situation. The year 2005 was officially designated as the year of agriculture, and even if the officials knew better, they might have been reluctant to admit to Kim that their campaign had come up short. After all, only a few years earlier Kim had ordered that his agriculture minister be publicly executed for failing to deliver sufficient crops. Another possibility is that the North Korean military, which draws most of its food from domestic stocks, might have objected to the foreign aid monitors and pressured Kim to throw them out. Or perhaps the expulsion and readmission were simply ploys to force the WFP and other aid organizations to be more responsive to North Korean demands for reduced monitoring.
The Kims, father and son, have addressed the perennial food shortages in their own ways, relying on their intuition and on the advice of homegrown agricultural experts who recommend solutions consistent with the principles of the command socialist economy. Under Kim Jong-il’s rule, a four-prong attack on food shortages has been mounted. In a continuation of his father’s enthusiasm for creating more usable farmland, the younger Kim has emphasized “large-scale land rezoning” designed to combine smaller fields into larger ones suitable for mechanized agriculture, despite the lack of such machinery. Kim also pushed the “potato revolution,” the “seed revolution” (developing or importing seeds suitable for North Korea’s growing conditions), and the “two-crops-a-year farming policy” (typically corn and wheat in cooler weather and rice in the summer).67 None of these initiatives has materially increased the annual harvests, suggesting that the agricultural problem lies elsewhere.
Kim Jong-il must suspect that the key to improving harvests will be found in agricultural management, a perennial concern of socialist economists. One issue is how to “correctly combine the unified guidance of the state with the creative initiative at each unit” (to borrow North Korea’s words).68 Favorite prescriptions include injunctions to “rationally deploy” farming resources and pursue “farming-at-the-right-place” and “farming-at-the-right-time.” A second management problem concerns how to employ incentives, a perennial issue (discussed earlier) that the North Korean media discuss in the context of determining the “scientifically correct” combination of political, moral, and material incentives to use. Arguably the greatest boon to North Korean agriculture is right under Kim Jong-il’s nose, but he either refuses to see it or realizes that it is too dangerous to adopt. The productivity of farmers’ private gardens far surpasses the productivity of the collective and state farm fields. Farmers do not have to be told what seeds to plant in their gardens or when to plant them. That is to say, farmers are using the type of creativity that Kim wants them to use, but they are being creative outside the bounds of socialism, and this is not acceptable to Kim. In short, the most obvious way to increase agricultural production would simply be to give the land back to the farmers, like the Chinese government did beginning in the late 1970s.
The Kim regime holds its people hostage to hunger, and dealing with hostage takers involves making distasteful compromises. Kim obviously cares less about his people’s welfare than do international aid organizations, not just because he is hard-hearted but because he is concerned first and foremost about his own security, which he believes foreigners threaten—thus the strange and unfortunate situation in which food-aid donors must plead to be allowed to continue to feed the North Korean people.
When all is said and done, North Korea remains as dependent as ever on foreign food aid and has manipulated the international community in order to continue receiving it on the best possible terms. Direct aid from South Korea and China is preferred over aid from the WFP, which is accompanied by more monitoring. The South Korean government under Presidents Kim Dae-jung and Roh Moo-hyun bristled at the charge that it was not doing enough to track where its donated rice was going, but the numbers speak for themselves. According to a South Korean newspaper, in 2004 only ten South Korean inspections were made of the distribution of over three hundred thousand tons of rice, whereas the WFP made over four thousand spot inspections.69 The same article reported the ROK unification ministry’s explanation: “Because it [rice aid] was given as a loan, we are limited in terms of our participation in the distribution process.”70 This refers to the pretense that some aid is in the form of a loan, despite the fact that nobody expects the loan will ever be repaid. As for China’s aid to North Korea, it is a matter between two secretive communist governments.
Haggard and Noland, in their study of the North Korean economy, have noted that as food aid began to arrive in the mid-1990s, the North Korean government cut back on its purchases of foreign food to the point where over 90 percent of food imports were in the form of aid.71 This action was taken even though the food aid was insufficient to save all North Koreans or bring them back to full health. So, not only does unmonitored bilateral aid seem to be crowding out WFP aid, but aid in general has crowded out commercial imports of food.
What is the Kim regime doing with its money and with its domestic food harvests? Much of the domestic harvest goes to the military, in line with Kim’s “military-first politics,” and a considerable portion of the government’s income goes to the construction of monuments to the Kims. In an internal communication from August 2004, Kim supposedly boasted about how construction proceeded in the DPRK even during the famine period. The projects listed were the Kumsusan Memorial Palace (believed to have cost at least a hundred million dollars), statues, and other commemorative monuments built “for the indoctrination of revolutionary tradition.”72 Reports in 2006 indicate that Kim Jong-il museums are being built throughout the country to supplement the Kim Il-sung museums found in every city, province, and county.73
Health Care
International concern about North Korea’s chronic food shortages obscures another serious threat to the people’s health: their broken health-care system. The system is broken not because of any shortage of qualified medical personnel, although North Korea’s doctors have limited access to cutting-edge medical knowledge, but because the collapse of the economy has deprived medical personnel of equipment and medicines to work with, and malnutrition makes people vulnerable to a host of ailments. After the introduction of the July 2002 economic-management measures, which shifted the burden of living costs to the people, the government promised to continue providing free health care, but descriptions of the health-care system in the North Korean press bear little resemblance to actual conditions.
Workplace accidents are common. Construction work performed with machinery in developed societies is done by hand. Mines are death traps. “Speed battles” force workers to work too quickly under exhausting conditions. A German technical advisor who worked for several foreign aid organizations in North Korea reported that North Korean managers considered adequate safety measures an extravagance, and he noted that in the provinces doctors were forced to amputate the limbs of injured workers because they did not have instruments and medicines for surgical treatment.74
According to a United Nations Children’s Fund (UNICEF) report, as the economy deteriorated during the 1990s, the availability of potable water declined: in 1994, 83 percent of North Koreans had access to piped water, but by 1998 only 53 percent did.75 Without electricity to run pumps, high-rise apartment buildings are without water except during a few hours in the morning and evening. According to a survey conducted by the DPRK government and jointly sponsored by UNICEF and the WFP, only about half of North Korean households have flush toilets.76 Outside of Pyongyang, chlorine to purify drinking water is in short supply, and pumping stations often cannot operate for lack of fuel and spare parts, forcing people to get their water from the nearest stream or river, which is often polluted because waste-treatment plants are not operating.
Since the 1960s, public health care (t
here is, of course, no legal private care) has taken the form of a “doctor-in-charge” system whereby a general practitioner, an obstetrician, and a pediatrician are assigned to a geographical area or designated workplace comprising about fifteen hundred persons. Patients are first seen in local clinics. More serious cases are supposed to be referred to a local hospital, then up to a county hospital, then to a hospital in the provincial capital, and finally to a hospital in Pyongyang. In fact, none of these medical facilities has adequate medicine or equipment to treat serious cases, except for a few of the Pyongyang hospitals that treat the elite cadres. The most famous of these elite hospitals is the Pyongyang Maternity Hospital, a favorite spot for North Korean officials to take foreign visitors in order to demonstrate the alleged superiority of their health-care system. In 2004, a Korean Central News Agency article reported that Kim Jong-il had sent “scores of tons of wild honey to the hospital on at least 30 occasions,” along with “rare tonics including bear hoof, deer’s placenta paste, black hens and pine-nuts.” This list suggests that even at this hospital, modern (or at least modern Western) medicine is lacking, forcing doctors to resort to more traditional Asian herbal remedies, which in North Korea have come to be called “Koryo medicine.”77 Because indigenous (or Chinese-origin) medicine does not rely on foreign research and technology, the Kim regime is especially proud of it, in line with the official ideology of Juche, but North Korean doctors are sometimes skeptical of its effectiveness.78
Getting admitted to well-equipped hospitals like the Pyongyang Maternity Hospital, the Pyongyang Medical University Hospital, or the Kim Manyu Hospital is only a dream for most people. Even if those hospitals admitted ordinary people, which they rarely do, getting timely transportation to them would be extremely difficult. Travel from one city to another often takes days and requires the payment of bribes to get on trains, buses, or, most commonly, open-bed trucks, nicknamed ssobicha, or “service cars.” Most patients are treated locally with herbal medicines gathered and mixed by a physician or pharmacist. An article in the North Korean press praises local hospitals and clinics that procure their own medical supplies for their efforts to “lighten even a bit of the burden shouldered by the great general who takes great pains to promote the people’s health.”79 Patients in need of complicated operations or modern medicines such as antibiotics must pull through by themselves.
North Korea’s doctors perform as well as they can under the circumstances. As employees of the state, they receive only subsistence wages, although they benefit from gifts of food and homemade consumer goods donated to them by grateful patients. Doctors dedicated to treating their patients perform heroically, for example by using old X-ray machines that expose their own bodies to dangerous levels of radiation. What must be most difficult for medical professionals is the frustration of watching patients suffer and die from diseases that could easily be cured if the proper medicines and equipment were available. The World Health Organization has estimated that North Korea depends on foreign donors for 70 percent of its most basic drugs.80
Norbert Vollertsen, a German physician who worked as an advisor in North Korea from 1999 to 2000 and later became an outspoken critic of the Kim regime, documented some of these frustrating conditions: “There were no bandages, scalpels, antibiotics or operating facilities, only broken beds on which children lay waiting to die.”81 A German technical advisor to a foreign aid group reported, “The hospitals, nurseries, kindergartens, and schools I witnessed personally were, in a word, ‘hellish.’… Bacterial infection and diarrhea are epidemic in the regions outside of Pyongyang, and because pharmaceuticals such as antibiotics are depleted, most of the residents live with one or two kinds of chronic disease.”82
The North Korean government has been so unhelpful to visiting health-care workers that some of the foreign medical organizations, including Doctors without Borders, Oxfam, and CARE, have withdrawn from the country.83 Beginning in 2006, the International Red Cross scaled down its assistance programs, diplomatically noting that the year was “marked by increased complexities in the implementation of the programs.”84
In 2006 the (South) Korea Center for Disease Control and Prevention examined the health history of over one thousand North Korean defectors.85 The average North Korean defector was three inches (eight centimeters) shorter than his or her South Korean counterpart and weighed seventeen pounds (eight kilograms) less. Of the North Korean sample, 77 percent had contracted diphtheria and rubella, 64 percent mumps, and 53 percent measles; 44 percent had a history of carrying parasites (a figure twelve times higher than in South Korea). Syphilis was eight times more frequently found in defectors than in a comparable South Korean sample. The United Nations’ 2006 World Population Status Report estimated the life expectancy of North Korean men to be sixty-one years, compared to seventy-four years for South Korean men (the ROK Ministry of Health says seventy-eight years); the comparable figures for women were sixty-seven and eighty-two years. North Korea’s estimated infant mortality was forty-three, compared to South Korea’s three, per one thousand.86
On the other hand, an entire mini-industry is devoted to the health care of Kim Jong-il, who, along with his top cadres, has access to the Ponghwa (Bonghwa) Clinic, which appears to provide medical care comparable to that found in hospitals in developed countries. A handful of top cadres have also been permitted to travel abroad to receive medical treatment in Beijing, Moscow, and Paris, and top medical specialists are sometimes flown into Pyongyang to advise North Korean doctors on special procedures to treat Kim.
Housing
It is difficult to determine what housing conditions are for the average North Korean because foreigners are not permitted to visit their homes, although foreigners are occasionally invited to see the apartment of a model citizen in Pyongyang. The capital city was almost completely destroyed during the Korean War and rebuilt in a modern design. Under the direction of Kim Jong-il, the city got a major facelift to prepare for the Thirteenth World Festival of Youth and Students in 1989 with the construction of rows of thirty-and forty-story apartment buildings on Kwangbok (“liberation”) and Tongil (“unification”) streets.
Compared to most large cities, Pyongyang is serene and orderly. High-rise buildings set among parks and monuments line broad but empty streets. Except when sand blows in from China, the air is clear because there are few vehicles on the streets and few factories operating. Visitors often find the city not so much quiet as disquieting, like an enormous Potemkin village, although hidden behind the tall buildings one can glimpse neighborhoods with winding streets and old-style tile-roofed houses.
The top cadres in Pyongyang live in large apartments or detached homes with small gardens located in neighborhoods surrounded by guarded walls to keep ordinary Koreans well away. They may also enjoy the use of a modest dacha in the countryside. Officials of somewhat lower rank live in high-rise apartments of three or four rooms, while mid-level officials get a one- or two-room apartment. Many people in Pyongyang and other cities live in single-story multiplex buildings of simple design or in traditional Korean dwellings. In the countryside, old tile-roofed and some thatched-roof houses from the early twentieth century can still be found.
The most prominent building in Pyongyang is the 105-story pyramid-shaped Ryugyong (Ryukyong, Yukyong) Hotel, designed to be Asia’s tallest hotel. Construction began in 1987 and was supposed to be completed in time for Kim Il-sung’s eightieth birthday in 1992. However, work stopped in 1989, and the French consultants withdrew the following year, complaining they were not being paid. Because of structural flaws and lack of materials, only the superstructure and façade were completed, and the building remains an empty eyesore overlooking Pyongyang, with a construction crane still perched at the top. There has never been an official explanation of what happened, and the North Korean media never mention the structure, even though it dominates the Pyongyang skyline. In 2009 Orascom, an Egyptian construction company, installed glass panels on the building to make it
look less abandoned.
Visitors to Pyongyang stay at one of a handful of hotels catering to foreigners, the most popular being the twin-towered Koryo Hotel and the newer Yanggakdo Hotel, which is located on a small island in the Taedong River. Power outages in these hotels are less frequent than in other buildings, but to conserve electricity hallways are kept unlighted most of the time. High-ranking foreign officials visiting Pyongyang are usually put up in government-owned guesthouses.
The state or a collective owns most dwellings in North Korea, although it is said that in the countryside there are some old homes that the communists never nationalized because their owners were from solid working-class stock. Until July 2002, housing was almost free, but under the new economic-management measures, the government now charges rent on homes and fees for utilities. As in other socialist countries, housing in North Korea has always been in short supply. Extended families often live in two-room apartments, and newlyweds typically wait several years before they can move into their own apartment.
Power outages are a daily occurrence, and residents of smaller cities and towns may be without electricity for days or even weeks at a time. At night, people use kerosene lanterns and candles for lighting, even in Pyongyang’s high-rise apartment buildings. Streets are not lit, but monuments to the Kim family are brightly illuminated. Without power, there is no running water or elevator service. Only the homes and apartments of the elites enjoy central heating. Other residents warm themselves with small stoves, insulate their windows with vinyl sheeting, and huddle under blankets.
The head of the inminban (neighborhood or people’s group consisting of twenty to forty households), who is usually a housewife or retired worker, recruits residents for all manner of local activities, including neighborhood security, cleaning, maintenance, recycling, and road repair. The group leader also checks to see that the households participate in required communal activities, including composting and farming assistance. In apartment buildings, residents take turns acting as security guards, recording the comings and goings of nonresidents.