HONG KONG—The ruling Workers' Party in North Korea is failing to deliver basic health care to its citizens, according to an international rights group, although U.N. health officials have defended the isolated Stalinist state.
"The people of North Korea suffer significant deprivation in their enjoyment of the right to adequate health care, in large part due to failed or counterproductive government policies," Amnesty International wrote in a recent report.
"These poor policies include systematic failure to provide sufficient resources for basic health care."
Based on interviews with 40 North Korean defectors and foreign health care workers, the report said that widespread and chronic malnutrition had triggered epidemics and mass outbreaks of illnesses related to poor diet.
North Korea regularly faces food shortages, and a widespread famine in the 1990s killed up to 2 million people.
While the government claims the country has a universal and free health care system, the reality on the ground looks very different, according to the Amnesty report.
"Health facilities are run down, and operate with frequent power cuts and no heat," it said.
"Medical personnel often do not receive salaries, and many hospitals function without medicines and other essentials."
To make matters harder for a cash-strapped population in the wake of a currency devaluation, doctors have begun charging for their services, which is illegal under North Korea’s universal health care system, the group said in its report, titled "The Crumbling State of Healthcare in North Korea."
"The poor cannot access full medical care, especially medicines and surgery," it said, adding that the government has also failed in its obligation to provide adequate public health information.
"Because many hospitals no longer supply free services or medicines (despite government commitments to the contrary), many people normally do not visit doctors even when they are ill," the report said.
WHO defends Pyongyang
The World Health Organization (WHO), which runs aid programs in North Korea, was quick to defend Pyongyang.
While North Korea still faces challenges in its provision of basic health care, WHO director-general Margaret Chan said the country has some advantages over other developing countries.
On returning from a three-day visit to North Korea, where she had wide-ranging discussions with key officials and visited several health facilities, Chan said there is no shortage of doctors and nurses in North Korea, because health professionals rarely emigrate.
She said the country has an "elaborate" health infrastructure and has developed a network of primary health care physicians.
Each of these household doctors is responsible for the well being of 130 families.
Chan praised Pyongyang's efforts in the areas of immunization coverage and effective implementation of maternal, newborn, and child health interventions, in providing effective tuberculosis treatment, and in successfully reducing malaria cases.
"Despite these successes, there are challenges," she said.
"More investments are required to upgrade infrastructure and equipment and to ensure adequate supplies of medicines and other commodities, and to address the correct skill mix of the health workforce."
She agreed with the Amnesty International report in its emphasis on nutrition as a cornerstone of public health.
She also called on the North Korean government to pay particular attention to the nutritional status of infants and pregnant women.
Rock-bottom spending
WHO figures indicate that North Korea spends less than U.S. $1 per person per year on health care.
Amnesty International called on the North Korean government to ensure that food shortages are acknowledged and that effective steps are taken to address them.
It said Pyongyang should take steps to ensure the need-based and equitable distribution of health facilities, goods, and services throughout the country, and cooperate with international aid organizations.
It said the government must ensure that medical personnel are paid adequately and regularly, provide accurate and comprehensive information on prevalent infections and diseases, and educate people about the importance of medical diagnosis and effective use of medicines.
The Global Fund to Fight AIDS, Tuberculosis, and Malaria, and GAVI—the Global Alliance for Vaccines and Immunization—have all agreed to support health programs in North Korea, according to Chan.
"I can confirm, at least in the area of health, the government is receptive to engagement with international partners," Chan said. "So, I think this is, to me, very good signs and signal."
Original reporting by RFA's Korean service. Director: Max Kwak. Written for the Web in English by Luisetta Mudie. Edited by Sarah Jackson-Han.