October 22, 2010

Health and Migration Concerns Increase for the Future of North Korea

With the international community's continued focus on North Korea's nuclear weapons program, humanitarian concerns for the North Korean people remain largely overlooked. With this in mind, panelists met at the United States Institute of Peace on October 19th to discuss the state of North Korea’s healthcare system and the migration of North Koreans to China and South Korea.

The event panel included Gilbert Burnham, professor of international health and co-director of the Center on Refugees and Disaster Response at the Johns Hopkins Bloomberg School of Public Health, W. Courtland Robinson, assistant professor of international health also at the Johns Hopkins Bloomberg School of Public Health, and John S. Park, senior research associate at USIP’s Center for Conflict Analysis and Prevention. USIP's Health and Peacebuilding Working Group Coordinator Leonard S. Rubenstein moderated the panel. The U.S. State Department's Special Envoy for North Korean Human Rights Issues Ambassador Robert R. King was also present at the event.

Burnham and Robinson recently returned from a research trip to the Northeast Asia region. Both focused on the health of North Koreans — Burnham on the North Korean health system, and Robinson on the areas where North Koreans have migrated to—specifically in northeastern China.

Burnham said North Korea’s health system is made up of several different smaller institutions—county hospitals, provincial hospitals, and national referral hospitals—which vary in their functionality. He talked specifically about the difference between two hospitals he visited, the National Maternity Hospital in Pyongyang and a rural hospital. The Pyongyang facility had up-to-date machinery and very few patients per health worker, while the rural hospital had older technology and many patients per health worker. During his visit, he also observed that the national hospital had electricity while the rural hospital did not.

Burnham said North Korea has released numbers concerning those who receive treatment for injuries and diseases, as well as percentages pertaining to infant and adult mortality and illness. UNICEF also did research in North Korea, and released numbers that are significantly higher to North Korea’s number in most cases. For children in the country, diarrhea and respiratory problems are the major causes of death. Many people have tuberculosis, are malnourished, and have hepatitis. Based on his observations, Burnham believes that many North Koreans with tuberculosis do not have access to the regular supply of medicine required for effective treatment, which can cause their tuberculosis to become drug resistant and more difficult to treat.

Burnham noted that healthcare workers in North Korea are also not working in the best conditions. “The general feeling is that hospitals probably reached their peak in the 1990s,” he said.

Many doctors are using fluoroscopic X-ray machines that have been associated with radiation poisoning, and as a result many healthcare workers have eye tumors. North Korea only has 10 medical universities where all the medical professionals are trained. When Burnham visited the Medical University of Pyongyang he found that the majority of medical students spent several hours a day farming their own food in addition to training.

Robinson added that North Korean migrants in China reported that North Korean doctors often take bribes or require gifts from patients to provide treatment. Robinson said based on a research study which looked at migration from September 1999 through September 2008, many factors including healthcare contribute to migration. South Korea has also seen an increase in tuberculosis and other diseases in tandem with the decreasing quality of North Korea’s health services; he said he sees a connection between migration and this increase as well.

Migration from North Korea between the 1950s and 1980s was limited, but was followed by the “Arduous March” in which people migrated to China because of acute food scarcity in North Korea. This migration period peaked in 1998, according to Robinson. Since then, he said migration has been declining overall and the majority of migrants are women. Many of these women come to China as part of arranged marriages to Chinese men, because of the greater number of men than women in China.

Robinson said that as a result, there are a large number of children born to North Korean mothers and Chinese fathers in the northern border region of China. The Chinese government does not always recognize these children as Chinese, and the children are sometimes abandoned when their mothers are deported. Although it appears migration has decreased, there are still migrants in this area who live in hiding, mainly in rural communities where the Chinese security officials rarely visit.

Park’s USIP working paper “North Korea, Inc.: Gaining Insights into North Korean Regime Stability from Recent Commercial Activities,” examines the growth of commercial interactions along the Sino-North Korean border. His interviews with North Korean defectors revealed an interesting connection between the growth of these markets and some of the migration patterns.

“Informal markets in North Korea initially sprung up after the Great Famine in the late 1990s,” said Park. “With the collapse of the Public Distribution System – the state rationing system – these informal markets served as an important survival mechanism through which North Korean people living in the Sino-North Korean border region could engage in non-state-sanctioned trading and bartering. Gradually, these markets also became vital places where medicine from China could be purchased.”

Park also said that health and migration are affected by the market relationships between North Korea and China.

“With respect to health and migration, China plays a critical role through informal markets,” Park noted.

Increasing low-level trading activities between North Korea’s North Hamgyong province and China’s Jilin province have produced what Park calls “Ham-Ji” – a localized phenomenon where more North Koreans are spending larger amounts of time engaging in commercial transactions in Jilin to either sell North Korean-produced items or procure cheap Chinese consumer products to be sold in North Korean informal markets.

“The expansion of this “Ham-Ji” phenomenon will have major implications regarding the health and migration of North Koreans in this border area,” Park stated.